National Journal glaucoma / Национальный журнал глаукома
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Сравнительная характеристика антиоксидантной активности аналогов простагландинов для местного лечения глаукомы
Get PDFPURPOSE: Intraocular pressure (IOP) lowering generally slows the progression of glaucoma, but does not necessarily stop the continuing vision loss. Growing evidence supports the idea that retinal ganglion cells in glaucomatous eyes are under oxidative stress that is associated with pathogenic mechanisms leading to glaucomatous neurodegeneration. Antioxidant protection plays a key role in the conditions of oxidative stress. Therefore, the antioxidative therapy might be of help in preventing glaucomatous neuron degeneration. Prostaglandin (PG) analogues are currently the treatment of choice for glaucoma, because maximum intraocular pressure reduction is derived by once daily application without any systemic side effect in all types of glaucoma. PG analogues, as well as other ocular hypotensive drugs, have been expected to have an additional effect to protect neurons independently of IOP reduction. Purpose оf this study was to compare the antioxidant activity (AOA) of the most widely used prostaglandin analogues. METHODS: The model of oxidation-induced haemolysis was used to study AOA of Latanoprost 0.005% (“Pfizer”), Travoprost 0.004% (“Alcon”), and Bimatoprost ophthalmic solution 0.03% (“Allergan”). Compounds with antioxidant activity inhibit hemolysis caused by free radicals. The degree of hemolysis was determined by the change in hemoglobin concentration in the incubation medium. RESULTS: Travoprost was found to have the highest AOA (17%). However it decreased upon adding larger quantities of the drug into the model system. In contrast to this, bimatoprost showed an increase in AOA when investigated in larger quantities. Its AOA peaked at 38% in 120 mcl of bimatoprost. АОА in latanoprost was the lowest. Upon reaching 120 mcl, latanoprost exhibited oxidative properties. CONCLUSION: Antioxidant activity in PG analogues differs which must be taken into consideration when choosing them as the agents with IOP independent neuroprotective properties
Применение гистохрома в лечении больных первичной открытоугольной глаукомой
Get PDFPURPOSE: To study the efficiency of complex treatment of primary open-angle glaucoma (POAG), that includes histochrome application both intraoperatively in the course of trabeculectomy (STE) and combined with magnetic therapy in the early postoperative period. METHODS: 30 patients (age 69±1.6) diagnosed with POAG stages I-III with increased intraocular pressure were included in the study. Two groups were formed: main group comprised 15 subjects who underwent STE combined with histochrome application and magnetic therapy, while 15 patients of the control group underwent standard STE. All patients before and after treatment on the 10th day, after 1, 3 and 6 months were surveyed, including visometry, biomicroscopy, gonioscopy, ophthalmoscopy, tonometry, perimetry, the definition of critical frequency of flicker fusion and HRT. RESULTS: The following results were obtained in the control group: a more prominent decrease of intraocular pressure (from 27.7±0.91 to 14.4±0.93 on the 10 day and 17.2±1.2 6 months after surgery), a trend towards stabilization of visual acuity; widening of the field of view (from 426±31.7 to 487±25.3 1 month and 488±20.2 6 months after the surgery); improvement of the morphological parameters of the optic disc: Rim Area - from 0.996±0.10 to 1.187±0.10 after 3 months and up to 1.212±0.14 after 6 months of follow-up; Rim Volume - from 0.140±0.03 to 0.226±0.05 after 3 months and up to 0.260±0.09 after 6 months of follow-up; Mean RNFL thickness - from 0.126±0.03 to 0.157±0.03 after 3 months and 0.170±0.04 after 6 months of follow-up. CONCLUSION: Complex treatment of primary open-angle glaucoma (POAG), that includes histochrome application both intraoperatively in the course of trabeculectomy (STE) and combined with magnetic therapy in the early postoperative period, can improve visual functions and stabilize the glaucoma process in to the course of 6 months follow-up period
Результаты модифицированной непроникающей глубокой склерэктомии в лечении первичной открытоугольной глаукомы
Get PDFPURPOSE: To study the hypotensive effect of modified non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma. METHODS: 91 patients with primary open-angle glaucoma were included in the study. The patients were divided into two groups. The first group consisted of 47 patients (51.6%) who underwent modified NPDS with implanted nylon thread 5/00, the second group included 44 patients (48.4%), who underwent modified NPDS with “Xenoplast" drainage implantation. The modified NPDS technique included using a paralimbal approach to cut the conjunctive and separate it from sclera, followed by cutting a U-shaped scleral flap (3*2 mm) with its free edge facing the limb and base - the equator. A cutting edge was used to form a 3 mm deep scleral tunnel opening into subconjunctive space. After that, we cut a deeper rectangular scleral flap (1/3 of scleral thickness) and excised the peripheral part of corneal tissue in single block with the external surface of the Schlemm's canal, opening its lumen. A 5/00 nylon thread (“Xenoplast" drainage) was implanted into the formed tunnel in an anteroposterior direction, thus dilating it. The operation was finished by covering the filtration area with the superficial scleral flap and suturing the conjunctive. RESULTS: After 18 weeks follow-up, patients of Group I had IOP=19.2±1.9 mm Hg, with IOP compensation in 78.7% of patients; in Group II - 19±1,8 mm Hg and 79.5% respectively. CONCLUSION: This proposed NPDS modification might be considered a treatment of choice in patients with primary open-angle glaucoma, it had high hypotensive efficiency during 18 week postoperative follow-up (79.1% compensation rate); drainages of various materials can be used during this operation to enhance its hypotensive effect
Глаукома: что необходимо знать каждому пациенту. Часть 4. Как изменить свою жизнь, если у вас глаукома? Возможности реабилитации пониженного зрения
Get PDFBeing diagnosed with glaucoma tends to permanently change one's daily activities, but it is important for every patient to realize that glaucoma can be managed and generally kept from changing his life. The first part of the article explains what everyday personal habits - such as aerobic exercise - might be useful for glaucoma patients, which of them to avoid (Valsalva maneuver, weight lifting etc.) and which have no effect on glaucoma whatsoever (diet, alcohol consumption, caffeine intake, reading and watching TV). The second part of the article focuses on the importance of low vision rehabilitation services and understanding what treatments, practical aids, technology and training it has to offer. One of the two main options of the low vision rehabilitation is using special equipment to improve visual function, choice and variety of which is vast (lenses, special filters, cell phone technology, magnifiers with LED lights, video magnification, software, etc). Alternative approach is using adaptive strategies and techniques and “low-tech" solutions. The author also reminds that psychological counseling and treatment may be in question in some cases, since glaucoma patients with substantial vision loss are prone to depression. The difference in life with glaucoma is often one's ability to adapt, and incorporating devices and adaptive strategies in to daily life might help with that
Взаимоотношения структурно-функциональных параметров и уровня поперечной связанности коллагена склеры глаукомных глаз
Get PDFДифференциальный подход к лечению пациентов с первичной открытоугольной глаукомой
Get PDFPURPOSE: To evaluate Prolatan effectiveness in groups of patients with risk of glaucoma progression. METHODS: We used Moriscos-Green/Blank clinical and psychological tests-scales of compliance to assess 190 patients with primary open-angle glaucoma (POAG). We revealed 57 out of 190 POAG patients (30%) to be insufficiently committed to their treatment. Among them were 22 (38%) women and 35 (62%) men with mean age 64.4±2.5 years. 18 (32%) patients were diagnosed with glaucoma within the last month before admission, while 39 (68%) patients had progressive glaucoma. All patients underwent standard ophthalmic examination and additional Humphrey standard automated perimetry (threshold 30-2 strategy) at baseline and after 3 months. RESULTS: Statistically significant non-compliance factors were the following: age over 60, male gender, POAG duration from 3 to 10 years, comorbid pathology, regimens comprising a large number of drugs, mild glaucoma, cognitive impairment and financial difficulties, hindering the purchase of medicinal products. On the average, Prolatan decreased IOP level by 33%. By the end of the 3rd month our study revealed retinal light sensitivity increase in all sectors of the visual field from 0 to 30 degrees due to IOP stabilization. CONCLUSION: Prolatan increases adherence to treatment by the end of the 3rd month of follow-up, which is associated with a reduction in the number of instillations, no side effects after instillation, patients’ good health during the treatment course, reduction of treatment material costs. ЦЕЛЬ. Оценить эффективность препарата Пролатан в группах риска прогрессирования глаукомы. МЕТОДЫ. С помощью клинико-психологической тестовой методики — шкалы комплаентности Мориски – Грин проведена оценка комплаентности 190 пациентов с первичной открытоугольной глаукомой (ПОУГ). Из 190 обследованных пациентов с ПОУГ недостаточно приверженными лечению были 57 (30%) пациентов. Среди них было 22 (38%) женщины и 35 (62%) мужчин, средний возраст составил 64,4±2,5 года. Впервые выявленная глаукома в течение 1 месяца была у 18 (32%) пациентов, некомпенсированная глаукома — у 39 (68%) больных. Проводили стандартное офтальмологическое исследование, дополнительно — статическую компьютерную периметрию на компьютерном периметре Humphrey по пороговой стратегии 30-2 исходно и через 3 месяца. РЕЗУЛЬТАТЫ. Достоверными факторами нон-комплаенса у обследованных больных были: возраст старше 60 лет, мужской пол, длительность ПОУГ от 3 до 10 лет, наличие коморбидной патологии и большое количество лекарственных средств, которые вынужден применять пациент, начальная стадия глаукомы, наличие когнитивных нарушений, финансовые затруднения пациентов при приобретении лекарственных средств. Снижение внутриглазного давления (ВГД) в результате применения препарата Пролатан составило 33%. На фоне стабилизации ВГД к концу 3-го месяца выявлено увеличение показателей светочувствительности сетчатки по всем секторам поля зрения от 0 до 30°. ЗАКЛЮЧЕНИЕ. На фоне лечения препаратом Пролатан увеличивается приверженность лечению к концу 3-го месяца наблюдения, что связано со снижением количества инстилляций, отсутствием побочных эффектов после закапывания, хорошим самочувствием пациентов во время лечения, снижением материальных затрат на лечение.
Диагностическая значимость исследования глазного кровотока в раннем выявлении первичной открытоугольной глаукомы
Get PDFPURPOSE: To compare the diagnostic value of regional blood flow indicators and choroidal thickness with other morphological and functional parameters in early glaucoma detection. METHODS: 30 normal eyes and 32 eyes with preperimetric glaucoma were analyzed in the present study. The thickness of the ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) and choroidal thickness (ChT) were measured using RTVue SD-OCT images. Perimetry - using Humphrey test (Carl Zeiss Meditec, Dublin, CA). Ocular blood flow velocity was measured by the color Doppler mapping (VOLUSON 730 ProSystem). Intraocular pressure (lOPcc) and corneal hysteresis (CH) were determined using Ocular Response Analyzer (ORA). As a measure of the parameter significance in early glaucoma detections, a value of the adjusted standardized statistic of the Wilcoxon-Mann-Whitney (z-value) and the area under the receiver operating characteristic (ROC) curve (AUC) were applied. RESULTS: The following parameters presented with the largest AUC score and highest z-values: the mean BFV in the vortex vein (AUC 1.0; z-value 5.35) and central retinal vein (0.85; 3.74), end diastolic BFV in the central retinal artery (0.73; 2.74) and temporal posterior ciliary arteries (0.71; 2.53), intraocular pressure (IOP) (0.74; -2.9), perimetric index Mean Deviation (MD) (0.72; 2.65), corneal hysteresis (CH) (0.69; 2.24), peripapillar ChT (0.69; -2.28), average GCC thickness (0.67; 2.05) and FLV (0.66; -1.86). CONCLUSIONS: The most informative clinical parameters in pre-perimetric glaucoma are blood flow indicators in vorticose veins, central retinal vein, central retinal artery and short posterior ciliary arteries, and the thickness of the peripapillary choroid, which indicates the role of hemoperfusion disorder in the progress of glaucoma and emphasizes the importance of ocular hemodynamic studies for early glaucoma detection
Классификации фильтрационных подушек
Get PDFThe bleb is the functional part of trabeculectomy, and the part that largely determines long-term success, failure, and complications. In many studies authors have described bleb appearance after glaucoma surgery in terms of recognized patterns of bleb appearance such as cystic, encysted, flat, and diffuse, usually in conjunction with a global vascularity assessment. Article describes all proposed bleb grading systems: the old ones (Kronfeld, Migdal, Hitchings, Vesti, Lederer and Shingleton), the most popular (Wuerzburg bleb classification score, Indiana bleb appearance grading scale, Moorfields bleb grading system). Also analyzed the modern concepts of bleb morphology using ultrasound biomicroscopy, optical coherence tomography, thermography and digital methods for assessing hyperemia level. In conclusion, the author tried to determine the role of each classification. Which characteristics are to be used as a descriptive, and which of them can predict the duration of the hypotensive effect of the surgery
Диагностическая ценность функциональных и морфометрических параметров сетчатки и зрительного нерва у пациентов с болезнью Альцгеймера
Get PDFPURPOSE: To evaluate the diagnostic value of morphometric, morphological and functional and parameters characterizing the state of the retina and optic nerve head (ONH) in patients with Alzheimer’s disease (stage of mild dementia) using computerized static perimetry and optical coherence tomography. METHODS: We examined 17 patients (34 eyes) with Alzheimer’s disease aged 59-82 years (mean age 71 years). All patients underwent a standard eye examination including visometry, computerized static perimetry on the visual field analyzer Humphrey Field Analiser II (HFA II) 750i (Germany) with the use of screening and threshold programs, biomicroscopy, ophthalmoscopy, Goldmann tonometry. Morphometric parameters of the optic nerve and the retina were assessed by optical coherence tomography (OCT) on the RTVue-100 (Optovue, USA). RESULTS: The study of the visual field in the threshold program 30-2 and 60-4 in patients with Alzheimer’s disease revealed the following patterns: a diffuse decrease in sensitivity, concentric arrangement of defects in the peripheral zone of the test visual field (central and peripheral), and a discrepancy between the results of research on threshold and screening programs. The study of morphometric parameters of the retina and optic nerve with OCT revealed diffuse thinning of the retina in patients with Alzheimer’s disease and an increase in the level of complex GCS volume global loss (GLV). CONCLUSION: The discrepancy between the results of visual field function study and morphometric parameters of the retina and optic nerve demonstrates low diagnostic value of the threshold study of computerized static perimetry in examining dementia patients with visual impairments, and can itself serve as a marker for dementia