5 research outputs found
Long-term outcomes of combined optimized YAG-laser trabeculostomy and selective laser trabeculoplasty for primary open-angle glaucoma
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A.S. Balalin, V.P. Fokin, S.V. Balalin, B.G. Dzhashi
Volgograd Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd, Russian Federation
Aim: to develop a combined technology of optimized YAG-laser trabeculostomy and selective laser trabeculoplasty and to evaluate its efficacy and safety in the treatment for primary open-angle glaucoma (POAG).
Patients and Methods: this study enrolled three groups of patients. Group 1 (study group, prospective) included 87 patients (87 eyes) with early and moderate POAG before and after optimized YAG-laser trabeculostomy. Group 2 (control, prospective) included 78 patients (78 eyes) with early and moderate POAG before and after selective laser trabeculoplasty (SLT). Group 3 (control) included 60 healthy individuals (60 eyes). A technique to determine the topography of the collector channels and Schlemm's canal was developed to perform YAG-laser trabeculostomy. The location of the collector channels was determined with regard to Schlemm's canal using anterior segment optical coherence tomography (OCT). Patients were followed up after 1 day, 1, 6, 12, and 24 months.
Results: after combined optimized YAG-laser trabeculostomy and SLT, a significant IOP-lowering effect (reduction in IOP level by 30.1%) was reported as early as day 1 after surgery. Meanwhile, after SLT, the maximum IOP-lowering effect (by 21.5%) was observed only 1 month after surgery. Over a year, a gradual decrease in the IOP-lowering effect (17.2%) was reported after SLT. After optimized YAG-laser trabeculostomy, the IOP-lowering effect was stable (by 30.1%) being 26.2% after 2 years. When comparing the percentage of IOP-lowering regimen, group 1 (after optimized YAG-laser trabeculostomy) patients used less combined medications (by 27.7%) than group 2 (after SLT) patients. Moreover, IOP-lowering therapy was canceled in 18.4% and 10.3% of patients, respectively.
Conclusion: YAG-laser and OCT optimize trabeculostomy by providing an alternative non-invasive laser treatment for patients with early and advanced POAG. Optimized YAG-laser trabeculostomy along with SLT (in contrast to SLT alone) reduces IOP faster, provides a more significant and stable IOP-lowering effect, and allows the surgery to be performed in the projection of the collector channels more accurately using acceptable laser energy values.
Keywords: glaucoma, trabeculostomy, selective laser trabeculoplasty, primary open angle glaucoma.
For citation: Balalin A.S., Fokin V.P., Balalin S.V., Dzhashi B.G. Long-term outcomes of combined optimized YAG-laser trabeculostomy and selective laser trabeculoplasty for primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2023;23(4):181–191 (in Russ.). DOI: 10.32364/2311-7729-2023-23-4-2.
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Pharmacotherapy for POAG. Individual approach
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S.V. Balalin, V.P. Fokin
S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd branch, Volgograd, Russian Federation
Glaucoma is still one of the leading causes of the blindness and low vision. According to the World Health Organization, an estimated number of glaucoma patients is 60.5 to 105 million and is growing steadily. In many highly developed countries, glaucoma accounts for 13–28% of blindness. High intraocular pressure (IOP) is the most important risk factor for glaucomatous optic neuropathy and low vision in primary open-angle glaucoma (POAG). It was demonstrated that IOP lowering to the individual tolerant level in POAG preserves vision for a long time.
The paper discusses potential adoption of of the software for the calculation of tolerant IOP in POAG. Tolerant IOP calculations will help to adjust treatment in time to achieve individual IOP normal ranges, to predict glaucoma stabilization or progression as well glaucoma progression rate. The algorithm of treatment strategy for POAG is described.
Key words: glaucoma, primary open-angle glaucoma, intraocular pressure, tolerant IOP, glaucomatous optic neuropathy, prostaglandin analogue, latanoprost, Trilactan.
For citation: Balalin S.V., Fokin V.P. Pharmacotherapy for POAG. Individual approach. Russian Journal of Clinical Ophthalmology. 2019;19(1):43–48.
About the authors:
Sergey V. Balalin — MD, PhD, Head of the Scientific Department of the Volgograd branch;
Viktor P. Fokin—MD, PhD, Professor, Director of the Volgograd branch.
S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd branch. 80, Zemlyachki str., Volgograd, 400138, Russian Federation. Contact information: Sergey V. Balalin, e-mail: [email protected]. Financial Disclosure: no author has a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 23.10.2018.<br
Эффективность Ксалатамакса в лечении начальной стадии первичной открытоугольной глаукомы
No full textPURPOSE: To evaluate the efficacy of latanoprost 0.005% treatment for patients with primary open-angle glaucoma during follow-up from the positions of individual IOP level achievement, eye hemodynamics improvement and visual functions stabilization. METHODS: The study included 186 patients with an initial stage of primary open-angle glaucoma (186 eyes) with pseudoexfoliative syndrome. The average age of the patients was 60.4±0.6 years. RESULTS: Individual IOP level was achieved in 119 patients with initial stage primary open-angle glaucoma (119 eyes) - 64% of cases. After latanoprost 0.005% instillation the average IOP value in patients with glaucoma decreased from 22.4±0.7 mm Hg to 15.1±0.7 mm Hg, totaling a decrease of 7.3 mmHg (32.6%) from baseline IOP and fitting into the tolerable IOP green zone (t=7.4; p=0.001). In 67 patients with glaucoma (67 eyes) required a combined drug treatment to reach a needed IOP level. Ophtalmosphygmography showed a significant improvement of hemodynamic parameters of the eyes after intraocular pressure reduction to tolerable IOP level (p=0.001). CONCLUSION: Ophthalmosphygmography parameters (intraocular vessels elasticity index, eye blood supply adequacy index) can be used as hemodynamic criteria in evaluating the effectiveness of primary open-angle glaucoma patients treatment. Glaucoma process stabilization was observed in 95.8% of patients with initial stage of primary open-angle glaucoma after IOP reduction to the individual tolerance level due to latanoprost 0.005% instillation
Объемные показатели офтальмогемодинамики при миопии и сопутствующей глаукоме с «нормализованным» давлением
No full textPURPOSE: To study volumetric measurements of ocular hemodynamics in patients with myopia and primary open-angle glaucoma with statistically normal IOP on hypotensive medication. METHODS: The study included 326 eyes (206 patients) with myopia and glaucoma with IOP < 21 mmHg. All patients were divided into two groups depending on their age and axial length (AL) of the eye. Group 1 consisted of 132 eyes on hypotensive treatment with IOP exceeding their individual norm. Apart from standard ophthalmological examination all patients underwent flowmetry by means of Ocular Blood Flow Analyzer to determine the volumetric measurements of their ocular hemodynamics. RESULTS: The study revealed the volumetric blood flow in eyes with myopia and non-progressive glaucoma to be equal to or insignificantly differ from the calculated norm if actual IOP is inferior to or equals the individual ocular pressure norm. A statistically significant decrease in the volumetric blood flow was detected in eyes with myopia and progressive glaucoma if actual IOP exceeded the individual ocular pressure norm. The blood supply deficiency was significantly more pronounced if AL exceeded 25 mm. CONCLUSION: Patients on with myopia and glaucoma have shown a build-up in blood supply deficiency if their actual IOP on hypotensive medication exceeded the individual ocular pressure norm, as opposed to the patients whose actual IOP was compensated in relation to the individual norm. At the same time, the excess rate of IOP over the individual norm was lower than the blood supply deficiency, which leads us to believe, that the blood supply deficiency depends on both: the excess of IOP and the individual specifics of the vascular system in eyes with combined pathology (myopia and glaucoma)
Анализ заболеваемости глаукомой населения Республики Башкортостан
No full textPURPOSE: Examine glaucoma incidence in the Republic of Bashkortostan (RB) over the 2010-2015 period.METHODS: The data of «Medical Information and Analytical Centre of the Ministry of Health of Bashkortostan Republic» for 2010-2015 was analyzed during the research. We calculated the level of general and primary incidence per 100 thousand population, growth rate, share of glaucoma in the structure of the eye diseases and preventive medical examination rate. Indicators of general and primary disease incidence in Bashkortostan in comparison with similar indicators in the Russian Federation (RF) in 2010-2015 were analyzed.RESULTS: Glaucoma incidence analysis showed an increase of its share in the structure of general and primary incidence among different population groups for 2010-2015. The study revealed general glaucoma incidence growth among general and adult population by 12.1% and 13.4% correspondingly compared to 2010. General incidence indicator decreased by 5.0% among the elderly population. Both primary incidence and preventive medical examination rate also increased in comparison with 2010. An increased primary disease incidence was marked in all age groups: among the entire population — by 48.6%, among the adult population — by 48.5% and among the elderly population — by 23.5%. Indicators of general and primary incidence in Bashkortostan were higher than national average.In 2015, in the Republic of Bashkortostan 7.3 patients per 1,000 general population, 9.3 patients among the adult population and 25.0 patients among older working age population were subjects to regular glaucoma check-up, which was higher than in 2010 by 21.7, 22.4 and 5.5% respectively.CONCLUSIONS: The research revealed an aggravating epidemiological situation with glaucoma in the Republic of Bashkortostan. General and primary incidence rates analysis showed negative trends in various demographic groups of this disease
