13 research outputs found
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
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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Clinical significance of determining individual intraocular pressure in patients with primary open-angle glaucoma in ophthalmological practice
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S.V. Balalin1, V.P. Fokin1, O.V. Yuferov1, S.Z. Boskhomdzhieva2
1 S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd branch, Volgograd,
Russian Federation
2 Zhemchuev Republican Clinical Hospital, Elista, Russian Federation
Aim: to determine tolerant IOP in patients with primary open-angle glaucoma (POAG) and to evaluate the effectiveness of drug therapy for glaucoma.
Patients and Methods: tolerant IOP was determined using software and the effectiveness of drug treatment was analyzed in 341 patients with primary open-angle glaucoma (498 eyes). The average age of the patients was 69.5±0.39 years. Patients were divided into groups according to the level of IOP (P0, mm Hg), which was measured against the background of the initial drug therapy: with normal values of ophthalmotonous (fr om 11 to 21 mm Hg) — 69.7% (347 eyes), with moderately increased IOP values (fr om 22 to 32 mm Hg) — 26.5% (132 eyes) and high IOP values (over 32 mm Hg) — 3.8% (19 eyes). Prognosis of the progression rate of the glaucomatous process was estimated by the intolerance index (Iint).
Results: the mean value of true IOP against the background of the initial drug therapy was 19.5±0.3 mm Hg, and the mean value of the tolerant pressure was 16.3±0.05 mm Hg, the difference between them was statistically significant (t=10.7; p=0.001). The mean value of the intolerance index was 3.1±0.27 mm Hg. Prognosis of the progression rate of glaucoma was detected in 164 eyes (32.9%), wh ere the intolerance index exceeded 4.7 mm Hg. Slow progression of the disease was found in 154 eyes (30.9%), wh ere the intolerance index ranged from 0.5 mm Hg to 4.7 mm Hg. Prognosis of stabilization of the glaucomatous process was determined in 180 eyes (36.1%).
Conclusions: software application for the tolerant IOP determination in 36.9% of cases allowed to identify those needed to strengthen antihypertensive treatment among patients with POAG with normal ophthalmotonus values on the background of drug therapy and in 35,9% of cases to select patients for surgical treatment of glaucoma.
Key words: open-angle glaucoma, individual and tolerant intraocular pressure, evaluation of the effectiveness of antihypertensive treatment.
For citation: Balalin S.V., FokinV.P. , Yuferov O.V., Boskhomdzhieva S.Z. Clinical significance of determining individual intraocular pressure in patients with primary open-angle glaucoma in ophthalmological practice. RMJ “Clinical ophthalmology”. 2018;4:199–202.<br
Safety and efficacy of Tobramycin 0.3% + Fluormetholone 0.1% (eye drops) fixed combination as a preoperative preparation and postoperative management of patients with wet AMD after intravitreal injection of ranibizumab. An observational, noncomparative single-center study
No full textPurpose. To evaluate safety and efficacy of Floas-T® (Tobramycin 0.3% + Fluormetholone 0.1%) as a preoperative preparation and postoperative management of patients with wet form of age-related macular degeneration (AMD) before and after intravitreal injection (IVI) of anti-VEGF drugs. Material and methods. 50 patients (50 eyes) with the wet form of AMD were examined and divided into two groups. The first group included 32 patients (32 eyes) with wet form of AMD. The second group consisted of 18 patients (18 eyes) with primary (11 eyes) and advanced (7 eyes) stages of primary open angle glaucoma with normalized IOP and wet form of AMD. Results. There were no significant changes in ВСVA and tonometric IOP values in the two groups before and within 7 days after IVI of ranibizumab and Floas-T® instillations. Average value of individually tolerable true IOP in patients of the second group was 16,3±1,1 mm Hg, while average value of initial true IOP (14,7±2,56 mm Hg) pre-op was lower than tolerable pressure, indicating that individual norm of ophthalmotonus in glaucoma patients was reached. The difference between the mean values of ocular hydrodynamics in both groups before and 1 week after surgery was also statistically unsignificant (p>0.05). The difference between the mean values of the Schirmer I test was statistically unsignificant in patients in the two groups (p>0.05) before and after surgery, indicating the absence of Floas-T® effect on tear production. There were no local and systemic side effects of Floas-T® in 50 patients (50 eyes) during the observation period. Conclusion. Floas-T® had an anti-inflammatory effect without a decrease in the aqueous humor outflow, did not cause a significant increase in IOP in the early postoperative period, did not decrease tear production, and did not cause adverse local and systemic side effects. Floas-T® can be used as a preoperative preparation and postoperative management drug in patients with wet type of AMD as well as in combination with primary open angle glaucoma when achieving an individual level of intraocular pressure
CLINICAL AND FUNCTIONAL EYE INDICATORS IN CHILDREN WITH MYOPIA ON THE BACKGROUND OF APPLICATION OF VARIOUS METHODS OF OPTICAL CORRECTION AND FUNCTIONAL TREATMENT
No full textBiomechanical parameters of the eye with regression of the results of excimer laser correction of myopia
No full textЭффективность 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
Early and long-term outcomes of glaucoma surgery the results of multicenter study in CIS countries
No full textОбъемные 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)
Дифференциальный подход к лечению пациентов с первичной открытоугольной глаукомой
No full textPURPOSE: 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.
