National Journal glaucoma / Национальный журнал глаукома
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Опыт внедрения «Регистра глаукомных больных»
Get PDFPURPOSE: The study of epidemiological characteristics and condition of dispensary observation of patients with primary open-angle glaucoma in the Tyumen region with use of the Register of glaucoma patients. METHODS: In 2010 we assessed the dispensary observation of glaucoma patients over a period of 1999 and 2009. Out-patient medical records of 400 glaucoma patients of Tyumen region were studied retrospectively. The observation design included 5 visits, during which all patients underwent standard ophthalmological examination: visometry, tonometry with Maklakov tonometer, perimetry, ophthalmoscopy, gonioscopy. In the Regional ophthalmic dispensary an automated information system «Register of glaucoma patients of Tyumen region» was created (certificate No. 2011618588 registered 31.10.2011). RESULTS: In the course of glaucoma diagnostics stage I of glaucoma was detected in 76%, II - 13%, III - 8%, IV - 3%. Beta-blockers were used for glaucoma treatment in 79%. The surgical treatment of glaucoma was performed in 19.4%. «Register of glaucoma patients of Tyumen region» contains 7 646 records, 5 156 women (66%) and 2 513 men (33%). The Register includes patients in need of medical supervision in the Regional ophthalmologic dispensary: 1 624 patients with suspected glaucoma (21%), 360 monocular glaucoma patients (4.7%%), and patients with decompensated glaucoma, in need of rehabilitation actions (surgery, laser treatment, selection of hypotensive therapy) - 2 960 people (39%). CONCLUSION: The risk of vision loss from glaucoma is directly dependent on the duration of the disease. 7% of patients lose their vision (stage IV glaucoma) during the first 10 years. In most cases, beta-blockers are chosen for the local treatment of glaucoma. The use of the Register allows improving the quality of dispensary observation of glaucoma patients, as well as performing an analysis of the treatment methods and their effectiveness
Сравнительный анализ результатов гипотензивной операции с введением металлического дренажа в угол передней камеры и стандартной синустрабекулэктомии в хирургическом лечении рефрактерной глаукомы
Get PDFГанглиозные клетки сетчатки: возможности нейропротекции при глаукоме
Get PDFNeuroprotective therapy is a contemporary and promising direction in glaucoma treatment. This strategy involves retinal protection, as well as the protection of optic nerve fibers from damaging by various factors. Cell therapy is gradually finding its practical application in almost all areas of clinical medicine, including ophthalmology. The positive effect of cell transplantation is associated with several mechanisms, including the trophic one and therefore, retinal cells metabolic stress correction is an important aspect of neuroprotection in glaucoma.The review analyzes the current state of researching retinal ganglion cells as targets for glaucoma therapy and gives a general idea about the new approaches to the treatment of this disease with the use of cell technologies based on neuroprotection strategies. Нейропротекторная терапия является современным и одним из наиболее перспективных направлений в лечении глаукомы. Эта стратегия подразумевает защиту сетчатки, а также волокон зрительного нерва от повреждающего действия различных факторов. Клеточная терапия постепенно находит практическое применение почти во всех областях клинической медицины, в том числе и в офтальмологии. Считается, что положительное влияние трансплантации клеток обусловлено нескольки- ми механизмами, одним из которых является трофический, поэтому одним из важных аспектов нейропротекции при глаукоме является коррекция метаболического стресса клеток сетчатки.В обзоре анализируется современное состояние вопроса изучения ганглиозных клеток сетчатки как мишени для терапии глаукомы, дается представление о новых подходах к лечению этого заболевания с использованием клеточных технологий на основе стратегии нейропротекции.
Оптимизация лечебно-диагностического процесса у пациентов с первичной открытоугольной глаукомой
Get PDFPURPOSE: To create an optimal scientifically based system of management of diagnosis and treatment process (diagnosis, follow-up, rational medication treatment, surgical treatment) in patients with primary open-angle glaucoma. METHODS: The final protocol of combined analytical research and clinical multicenter study conducted from July to November 2015 included data from 591 patients (824 eyes). Age, disease duration, disease stage, IOP level and visual field parameters during treatment and treatment regimens were analyzed. Regimen included various combinations of medical, laser and surgical treatment used in the disease management. RESULTS: Average patients' age at the time of diagnosis establishment was 64.3 (57.5; 70.4). Mean disease duration was 4.1 years (2.0; 7.1). The administered regimen was considered to be effective when IOP level was below 20 mm Hg. The IOP level between 21 and 25 mm Hg was considered to be a sign of reduced treatment effectiveness and need for change of the regimen. 8 regimen changes were analyzed in total, though 90% of cases had 1-5 regimen changes. The first three regimens were used for 1.2 (0.4; 2.6), 1.3 (0.5; 2.5) and 1.1 years (0.5; 2.4) respectively. B-blockers and prostaglandin analogues monotherapy was used as a first-line therapy in 40.1% and 20.8% of cases respectively. Treatment was started with combination therapy in 27.82% of cases. Proportion of surgical treatment was 9.9% in regimen 2 and achieved 73% in regimen 5. Laser treatment was started from regimen 3 though the frequency of administration did not exceed 20%. Combination treatment using 3 and more components was found starting from regimen 5 (57.3%). CONCLUSION: First line therapy choice is still not rational in many cases. Laser and surgical treatment are used ineffectively after 3-4 years from the diagnosis
Анализ темпов прогрессирования глаукомного процесса при различных вариантах несоблюдения комплаенса лечения
Get PDFPURPOSE: To evaluate the influence of treatment compliance and follow-up care on the glaucoma process progression rate. MATERIALS AND METHODS: Glaucoma process progression analysis was performed on 90 patients with primary open-angle glaucoma (POAG). All patients were divided into 3 groups according to their non-compliance level. Group A had a zero compliance level (no treatment, no follow-up care after the diagnosis). Group B included those having partial compliance (not complying with the treatment regimen in full). Group C consisted of patients who complied with the treatment regimen in full, whereas the doctor didn't observe POAG treatment standards. 160 eyes were analyzed. Glaucoma process dynamics was assessed according to structural and functional changes that occurred within the period between two consultations in glaucoma centre (41.55 months on average). RESULTS: The first consultation in glaucoma center indicated early or moderate glaucoma in most patients (66 out of 90). The second consultation marked a significant aggravation. 86 patients were diagnosed with advanced or terminal glaucoma which was caused by the lack of intraocular pressure compensation between the two consultations. Average progression rate in all groups was a stage per each 2.5 years. The patients needed complex medication and surgical treatment. However, developed structural and functional changes prevented visual function improvement. CONCLUSION: The conducted analysis showed a high glaucoma process progression rate related to varied noncompliance due to a lack of intraocular pressure compensation. Glaucoma process progression rate was higher in Group A and Group B and lower in Group C. However, it was still high in Group C which indicates equal responsibility of both the patient and the doctor during a longterm follow-up and glaucoma treatment
Современные методы функциональной диагностики и мониторинга глаукомы. Часть 1. Периметрия как метод функциональных исследований
Get PDFGlaucoma is a chronic optic neuropathy, characterized by ganglion cell loss and specific changes in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL). Early glaucoma detection plays an important role in preventing permanent structural damage development and irreversible vision loss. Glaucoma diagnostics is based on examination of structural damage to the optic nerve and visual functions evaluation. The results of ONH and RNFL clinical evaluation are subjective and can vary to a great extent. As a result, much recent research has been devoted to developing additional objective diagnostic methods, such as the use of confocal scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography for evaluating the OHN status. In order to provide early detection of visual field defects some researchers consider the possibility of replacing standard automated perimetry (SAP) with the selective automated perimetry, that includes the short-wavelength automated perimetry (SWAP) and frequency-doubling technology perimetry (FDt). This article presents a review of modern methods available for glaucoma diagnostics with emphasis on their clinical use
Отдаленные результаты селективной лазерной трабекулопластики при псевдоэксфолиативной глаукоме
Get PDFPURPOSE: To assess the long-term efficacy of selective laser trabeculoplasty (SLT) in the treatment of pseudoexfoliative glaucoma (PEG) and primary open-angle glaucoma (POAG). METHODS: 75 patients with PEG (64 eyes) and 70 patients with POAG (63 eyes) were included in the study. The groups were homogeneous for age (69.67±0.93 years in PEG group and 65.63±0.33 years in POAG group, p = 0.09) and stages of glaucoma (MD -7.29±1.08 dB in PEG group and -5.95±1.12 dB in POAG group, p=0.39). Baseline IOP was 23.9±0.65 mm Hg in PEG patients and 21.4±0.44 mm Hg in POAG patients (p=0.002). The follow-up period was four years. RESULTS: There was a significant reduction of the IOP level in PEG patients after SLT as compared to the baseline at all stages of the study. By the end of the follow-up period the IOP was 19.00±0.97 mm Hg (p=0.023). A significant reduction of the IOP level in POAG patients occurred only during the first six months after surgery (IOP=18.92±0.46, p=0.000) and by the end of the follow-up period it was 20.8±1.13 (p=0.938). The amounts of topical ocular hypotensive drugs after SLT in the PEG group decreased from 1.69±0.107 to 1.45±0.092 (p=0.05), and in the POAG group - from 1.42±0.091 to 1.2±0.111 (p=0.137). There was no statistically significant progression of glaucomatous neuropathy in both groups: the MD index was not significantly changed in the PEG group during the follow-up period: -7.29±1.08 dB before SLT, and 7.6±1.36 dB in the late postoperative period (p=0.10), in the POAG group the index values were 5.95±1.12 dB and -6.63±1.28 (p=0.37) dB, respectively. CONCLUSION: SLT may be considered an effective and safe treatment for PEG patients, which not only significantly reduces the IOP level, but also helps preserve visual functions at least four years after the surgery
Влияние внутривенных инфузий ядросодержащих клеток плацентарной крови на состояние зрительных функций у пациентов с глаукомной оптической нейропатией
Get PDFPURPOSE: To assess the influence of cord blood nucleated cells intravenous infusion on visual functions state in patients with glaucomatous optic neuropathy. METHODS: 21 patients (27 eyes) with advanced primary open-angle glaucoma and normal intraocular pressure were included into the study. Group I included 11 patients (16 eyes) with high central visual acuity (over 20/40). Group II comprised 4 patients (5 eyes) with visual acuity around 20/200. Group III consisted of 6 patients (6 eyes) with residual visual functions. All patients underwent complex ophthalmological examination including viso-metry, tonometry with bidirectional applanation method, standard static perimetry (Humphrey Field Analyzer II), threshold of retinal electric sensitivity and lability of the visual analyzer and the critical frequency of flickering fusion (Lametesk). RESULTS: Cord blood nucleated cells tolerability remained good during the whole follow-up period. A decrease in IOP level by the second week of infusion therapy was revealed in all groups. By months 3 and 6 patients in groups I and II presented with a statistically significant positive dynamics in vision fields. Post treatment electrophysiological examination showed results stabilization in all patients of group II. Patients in group III lacked spatial vision, but despite initial grave changes in visual analyzer, all electrophysiological examination indices remained stable. CONCLUSION: Complex therapy with cord blood nucleated cells helps slow the progression of glaucomatous optic neuropathy
