National Journal glaucoma / Национальный журнал глаукома
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Оптическая когерентная томография в диагностике глаукомной оптиконейропатии. Часть 1
Get PDFSpectral domain OCT (SD-OCT) is the most promising approach in the early glaucoma detection (especially in pre-perimetric stage of the disease), and in the monitoring of glaucoma patients. In recent years, evidence has accumulated that both the thickness of the retinal nerve fiber layer (RNFL) and internal macular layers have important diagnostic value. According to the latest data, thickness of the retinal ganglion cells complex (GCC) is also as informative as the optic nerve head (ONH) parameters produced by SD-OCT. The new options, such as a global (GLV) and focal loss volume (FLV) of ganglion cells complex, are important as well. Today, a minimum rim width (MRW) and a minimum rim area (MRA) are considered among the most relevant parameters of the ONH. This review also presents study of the thickness of lamina cribrosa and choroid - the least studied aspect of glaucoma diagnostics. It also discusses the new developments in optical coherence tomography, which are of great interest for future research, but have not yet been introduced in clinical use
Кистозные изменения фильтрационной подушки после применения цитостатиков при антиглаукоматозной операции. Экспериментальные исследования
Get PDFВозрастные изменения структуры и биомеханических свойств фиброзной оболочки глаза (обзор зарубежной литературы). Сообщение 1. Структурные изменения
Get PDFThe sclera and cornea form the fibrous tunic of the eye which resists external and internal actions and maintains the shape of the eyeball. The functioning of these tunics is associated with their structural and biomechanical properties. Age-related changes of these properties affect protective and supporting functions of the sclera and cornea thus being direct or indirect cause of many ocular disorders. Structural changes of the fibrous tunic of the eye primarily consist in the disorientation of collagen, elastin, and proteoglycan fibers which are the basis of corneal and scleral stroma. Fibrils are disoriented, the number of cross-link bridges increases. Structural changes of ocular connective tissue affect its functionality, i.e., viscoelastic properties of the cornea and sclera. According to the foreign authors, a common tendency of age-related changes of the fibrous tunic of the eye is its stiffening and decrease in viscoelastic properties.Роговица и склера формируют фиброзную оболочку глаза, способную противостоять внешним и внутренним воздействиям и поддерживать форму глазного яблока. Функционирование данных оболочек связано с их структурными особенностями и биомеханическими свойствами, изменение которых с возрастом сказывается на способности выполнять защитную и опорную функции и является прямой или косвенной причиной ряда глазных болезней. Структурные изменения фиброзной оболочки глаза связаны в первую очередь с нарушением организации волокон коллагена, эластина и протеогликанов, которые составляют основу стромы роговицы и склеры. Происходит изменение организации фибриллярных компонентов и увеличение количества поперечных сшивок. Структурные изменения соединительной ткани глаза отражаются на ее функциональном состоянии, в первую очередь на вязкоупругих свойствах роговицы и склеры. Общей тенденцией возрастных изменений фиброзной оболочки глаза, по данным зарубежных исследователей, является увеличение жесткости и снижение вязкоэластических показателей
Возможности ноотропной терапии в комплексном лечении больных первичной открытоугольной глаукомой
Get PDFРезультаты каналопластики с использованием нового офтальмохирургического устройства
Get PDFPURPOSE: To conduct a comparative assessment of the effectiveness of non-penetrating deep sclerectomy (NPDS) and canaloplasty using the new GlauStent ophthalmic device and Glaucolight system in patients with primary open-angle glaucoma (POAG). METHODS: The study included 152 patients (177 eyes) with POAG of mild to advanced stages. Group I consisted of 57 patients (69 eyes), who underwent NPDS enhanced by the microperforation prevention method (patent 2595045). Group II included 45 patients (51 eyes) who underwent canaloplasty with Glaucolight device. Group III comprised 50 people (57 eyes), who underwent canaloplasty with the use of newly developed GlauStent device (patent N 162 617). RESULTS: During canaloplasty a cloudlike haemorrhage in anterior chamber aqueous humour due to blood reflux was detected in patients of Groups II and III in 52.9% (27/51) and 57.8% (33/57) of cases respectively. Maximum IOP decrease was observed immediately after the surgery. In patients with mild and moderate POAG stage IOP decreased by 67.6%, 72.2% and 73.5% in Groups I, II and III respectively. Whereas in patients with advanced POAG IOP level decreased by 70.4%, 68.05% and 66.4% in Groups I, II and III respectively. Relative hypotensive effect in patients with mild and moderate POAG stages by the end of followup period reached 77.7% (28/36) in Group I, 83.3% (25/30) in Group II, and 84.3% (27/32) in Group III. In patients with advanced stages of POAG relative success was achieved in 75.7% (25/33) and 71.4% (15/21) and 72% (18/25) of cases in Groups I, II and III respectively. CONCLUSION: The developed GlauStent canaloplasty ophthalmic device has a better Schlemm’s canal catheterization count compared to Glaucolight: 95% (57/60) vs. 85% (51/60). The developed method of protecting trabeculaeDescemet’s membrane reduces the risk of microperforation in NPDS. Canaloplasty for mild and moderate POAG provides IOP normalization in 84.3%, whereas relative hypotensive effect in advanced glaucoma patients amounted to 72% during 3 years of follow-up period. ЦЕЛЬ. Провести сравнительную оценку эффективности непроникающей глубокой склерэктомии (НГСЭ) и канало- пластики с использованием нового офтальмохирургического устройства GlauStent и системы Glaucolight у больных с первичной открытоугольной глаукомой (ПОУГ). МЕТОДЫ. В исследование включены 152 пациента (177 глаз) с ПОУГ I-III стадий. Первую группу составили 57 пациентов (69 глаз), которым проводилась НГСЭ, дополненная способом профилактики микроперфораций (патент РФ № 2595045). Во 2-й группе было 45 больных (51 глаз) — выполнена каналопластика устройством Glaucolight, в 3-й группе (50 человек, 57 глаз) — канало- пластика при помощи нового разработанного устройства GlauStent (патент РФ № 162617). РЕЗУЛЬТАТЫ. Во время проведения каналопластики у пациентов 2 и 3-й групп в 52,9% (27/51) и 57,8% (33/57) случаев соответственно было отмечено появление во влаге передней камеры облаковидных кровоизлияний за счет рефлюкса крови. Максимальное снижение внутриглазного давления (ВГД) отмечали непосредственно после операции. Так, у пациентов с начальной и развитой стадиями ПОУГ в 1, 2 и 3-й группах произошло снижение ВГД соответственно на 67,6; 72,2 и 73,5%, тогда как при далеко зашедшей стадии ВГД уменьшилось на 70,4; 68,05 и 66,4% соответственно. Относительный гипотензивный эффект у пациентов с начальной и развитой стадиями ПОУГ к концу наблюдаемого срока наблюдали в 1-й группе в 77,7% (28/36) случаев, во 2-й группе — в 83,3% (25/30) и в 3-й группе — в 84,3% (27/32) случаев. Однако при далеко зашедшей стадии ПОУГ относительная удача достигнута в 1-й группе у 75,7% (25/33) пациентов, во 2 и 3-й группах — в 71,4% (15/21) и 72% (18/25) случаев соответственно. ЗАКЛЮЧЕНИЕ. Разработанное новое офтальмохирургическое устройство для каналопластики GlauStent позволило улучшить катетеризацию шлеммова канала до 95% (57/60) по сравнению с Glaucolight — 85% (51/60). Разработанный способ защиты трабекулодесцеметовой мембраны уменьшает риск микроперфораций при НГСЭ. Каналопластика при ПОУГ начальной и развитой стадий обеспечивает нормализацию ВГД в 84,3%, тогда как при далеко зашедшей стадии глаукомы относительный гипотензивный эффект составляет 72% в сроки наблюдения до 3 лет.
Характер клинических проявлений ожогов глаз у пациентов с различным фенотипом ацетилирования при нормализованном внутриглазном давлении
Get PDFPURPOSE: To study the character of clinical manifestations of ocular burns in patients with normal IOP and different acetylation phenotypes (APh).METHODS: We examined 103 patients with ocular burns (141 eyes) during their primary visit to the Republican Clinical Eye Hospital of the Ministry of Health of Uzbekistan, on different time-points during therapy (on days 2, 5, 7, 12 after the beginning of treatment) and then during an active clinical examination 30 days and 4 months after discharge. 44 patients were examined 1-2 years after suffering a burn injury in order to identify the later post-burn complications and their interpretation according to the patient’s APh. 52 (69 eyes) patients out of 103 examined patients (141 affected eyes) had a slow acetylation phenotype (SA) and 51 patients (72 eyes) — a fast acetylation phenotype (FA).RESULTS: The results of these studies allow us to assert that patients with SA phenotype develop deeper ocular burns, with eye tissue damages less prone to treatment than in FA patients, where less pronounced changes lead to faster process normalization. APh determines the course of the manifestations, their severity and risk of complications in ocular burns patients. Fast acetylation phenotype may serve as a prognostic marker of faster pathological changes regression in ocular tissues, whereas the slow acetylation phenotype suggests the development of more severe disease forms, often requiring a prolonged and complex therapy.
Оптическая когерентная томография в диагностике глаукомной оптиконейропатии. Часть 2
Get PDFToday, the method of spectral optical coherence tomography (SD-OCT) is gaining the main role in the early diagnosis of glaucoma. The thickness of the peripapillary retinal nerve fiber layer (RNFL) is the most reliable clinical parameter in this regard. However, recent literature data suggests an important role of the study of the macular inner layers, in particular the parameters of ganglion cell complex (GCC), focal loss volume (FLV) and global loss volume (GLV) for the early glaucoma detection. In this regard, the study of the ONH and lamina cribrosa is of less diagnostic value. At the same time researchers are focused on minimum width of the neural rim (minimum rim width, MRW), - a promising new option in early glaucoma diagnostics. The application of SD-OCT for determining glaucoma progression is still under development. The review provides a comparative analysis of these methods for early diagnosis and monitoring of the disease. Limitations of OCT in glaucoma diagnostics are noted. The advantages of combining structural and functional evaluation methods in glaucoma diagnostics are also shown
Комбинированная непроникающая глубокая склерэктомия и факоэмульсификация с фемтосопровождением у больных с катарактой и глаукомой
Get PDFThe problem of cataract treatment in patients with coexisting glaucoma attracts attention of ophthalmologists for many years. Most of them prefer combined surgery in these cases. Antiglaucomatous component of such treatment - non-penetrating deep sclerotomy (NPDS) has less complications and Femtosecond laser assistance can decrease the trauma of phacoemulsification. PURPOSE: The purpose of this work was to evaluate the effectiveness and safety of femtoassisted phacoemulsification with NPDS in cases of glaucoma and cataract combination. MATERIALS AND METHODS: All the patients were divided to groups according to the procedure performed: 1) phacoemulsification (269 eyes, 213 patients); 2) femtoassisted phacoemulsification (461 eyes, 320 patients); 3) phacoemulsification with NPDS and Xenoplast drainage implantation (11 eyes, 7 patients); 4) femtoassisted phacoemulsification with NPDS and Xenoplast drainage implantation (53 eyes, 42 patients). RESULTS: Vision acuity before operation in average was: 1 group - 0.13; 2 group - 0.23; 3 group - 0.24; 4 - 0.14. 1 months after operation it was 0.67; 0.72; 0.66 and 0.68 correspondingly. IOP in first two groups 1 day after the surgery was identical. Femtolaser assistance in all cases decreased the intraocular working time. There were no cases of hemorrhage intraoperative complications. In groups of combined surgery IOP normalized by 5-10 day after the surgery. CONCLUSIONS:Combined phacoemulsification and NPDS with Xenoplast implantation is safe and effective procedure. Femtoassistance in cataract surgery can decrease intraocular operation time and doesn't lead to intraoperative and postoperative complications increase
Первичная сосудистая дисрегуляция и глаукома
Get PDFThe pathogenesis of glaucomatous optic neuropathy is still debated. Ocular blood flow (OBF) in glaucoma patients is generally reduced, particularly in patients with progression of damage in spite of a normal IOP. However, the question of whether this OBF reduction is only secondary to the damage or whether it is a primary causal factor has remained open for a long time. In this review, we try to explain why vascular dysregulation contributes to glaucomatous damage. In people with primary vascular dysregulation, the autoregulation of ocular perfusion is disturbed. Therefore, fluctuations in intraocular pressure (IOP) or blood pressure lead to an unstable oxygen supply. This in turn increases oxidative stress, particularly in the mitochondria of the optic nerve head (ONH). The simultaneous activation of the astrocytes leads to altered gene expression, which contributes to both tissue remodeling in the ONH and the death of retinal ganglion cells. The activated astrocytes produce more metalloproteinase degrading the extracellular matrix. This results in a remodeling of the extracellular matrix, which is basic component of ONH excavation
