Pub Date : 2022-11-24DOI: 10.53432/2078-4104-2022-21-4-37-47
A. L. Dmitrieva, V. Myasnikova, R. A. Avakimyan, T. R. Hutim, T. G. Zakaraiya
PURPOSE. To compare the course of the early postoperative period after Ahmed valve implantation in patients with neovascular glaucoma of diabetic and post-thrombotic genesis with and without anti-VEGF therapy.METHODS. This study included patients with refractory neovascular glaucoma of diabetic and post-thrombotic genesis who were indicated for Ahmed valve implantation. Some patients underwent intravitreal administration of ranibizumab 4–14 days prior to implantation. A total of 39 eyes from 39 patients were included in the study and divided into 2 groups: group 1 (n=20) — patients with refractory neovascular glaucoma of diabetic and post-thrombotic genesis with Ahmed valve implantation without prior anti-VEGF therapy; group 2 (n=19) — patients with refractory neo-vascular glaucoma of diabetic and post-thrombotic genesis with anti-VEGF therapy before Ahmed valve implantation. The following parameters were assessed: best corrected visual acuity (BCVA), intraocular pressure (IOP) before and after the intervention, and the course of the early post-operative period.RESULTS. In the group with prior intravitreal administration of ranibizumab, the incidence of hyphema was significantly reduced due to regression of the newly formed vessels. The study showed the best functional outcomes are achieved with the use of preparation therapy with anti-VEGF before Ahmed valve implantation: increase of corrected visual acuity by 34%, stabilization of initially elevated IOP by 100%. The baseline IOP of 29.9±6.6 mm Hg decreased to 9.7±3.6 mm Hg (p<0.05). The better visual results can be attributed to the reduced incidence of hyphema as a result of preoperative anti-VEGF therapy, which simplifies the surgical procedure. In addition, preoperative intravitreal injection of ranibizumab (IVI) improved best corrected visual acuity by relieving macular edema. Our study shows that the combination of Ahmed valve implantation and intravitreal injection of an anti-VEGF agent is successful in the early follow-up period, but fails to persist: an increase in IOP to almost 21 mm Hg was seen in both groups by the end of one-year follow-up, and visual acuity regressed in group 2.CONCLUSION. The use of anti-VEGF agent prior to Ahmed valve implantation provides better functional outcomes in the early postoperative period. Intravitreal administration of ranibizumab prior to Ahmed valve implantation minimizes the number of hemorrhagic complications in the early postoperative period and reduces the length of hospital stay. Within one year after surgery, patients experienced regression of visual acuity, as well as an increase in intraocular hypertension following the reactivation of iris neovascularization.
目的。比较抗vegf治疗和非抗vegf治疗的糖尿病和血栓形成后新生血管性青光眼患者Ahmed瓣膜置入术后早期的病程。本研究纳入了顽固性糖尿病新生血管性青光眼和血栓形成后患者，这些患者需要行Ahmed瓣膜植入术。一些患者在植入前4-14天接受了雷尼单抗玻璃体内给药。研究共纳入39例患者的39只眼，分为2组:1组(n=20) -糖尿病合并血栓形成后难治性新生血管性青光眼患者，既往未接受抗vegf治疗，行Ahmed瓣膜置入术;2组(n=19):在Ahmed瓣膜置入术前接受抗vegf治疗的难治性糖尿病新生血管性青光眼患者。评估干预前后最佳矫正视力(BCVA)、眼内压(IOP)及术后早期病程。在先前玻璃体内给予雷尼单抗的组中，由于新形成的血管消退，前房积血的发生率显著降低。研究显示，在Ahmed瓣膜植入前使用抗vegf预备治疗可获得最佳功能效果:矫正视力提高34%，初始升高的IOP稳定100%。基线眼压由29.9±6.6 mm Hg降至9.7±3.6 mm Hg (p<0.05)。较好的视觉效果可归因于术前抗vegf治疗减少了前房积血的发生率，这简化了手术过程。此外，术前玻璃体内注射雷尼单抗(IVI)通过缓解黄斑水肿改善最佳矫正视力。我们的研究表明，Ahmed瓣膜植入联合玻璃体内注射抗vegf药物在早期随访期间是成功的，但未能持续下去:一年后随访结束时，两组患者的IOP均升高至近21 mm Hg, 2组患者的视力有所下降。在Ahmed瓣膜植入前使用抗vegf药物可以在术后早期提供更好的功能结果。在Ahmed瓣膜植入前玻璃体内给予雷尼单抗可最大限度地减少术后早期出血并发症的数量并缩短住院时间。术后一年内，患者出现视力下降，虹膜新生血管再激活后眼内高压升高。
{"title":"Impact of angiogenesis inhibitors on the postoperative course of Ahmed valve implantation in patients with neovascular glaucoma","authors":"A. L. Dmitrieva, V. Myasnikova, R. A. Avakimyan, T. R. Hutim, T. G. Zakaraiya","doi":"10.53432/2078-4104-2022-21-4-37-47","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-4-37-47","url":null,"abstract":"PURPOSE. To compare the course of the early postoperative period after Ahmed valve implantation in patients with neovascular glaucoma of diabetic and post-thrombotic genesis with and without anti-VEGF therapy.METHODS. This study included patients with refractory neovascular glaucoma of diabetic and post-thrombotic genesis who were indicated for Ahmed valve implantation. Some patients underwent intravitreal administration of ranibizumab 4–14 days prior to implantation. A total of 39 eyes from 39 patients were included in the study and divided into 2 groups: group 1 (n=20) — patients with refractory neovascular glaucoma of diabetic and post-thrombotic genesis with Ahmed valve implantation without prior anti-VEGF therapy; group 2 (n=19) — patients with refractory neo-vascular glaucoma of diabetic and post-thrombotic genesis with anti-VEGF therapy before Ahmed valve implantation. The following parameters were assessed: best corrected visual acuity (BCVA), intraocular pressure (IOP) before and after the intervention, and the course of the early post-operative period.RESULTS. In the group with prior intravitreal administration of ranibizumab, the incidence of hyphema was significantly reduced due to regression of the newly formed vessels. The study showed the best functional outcomes are achieved with the use of preparation therapy with anti-VEGF before Ahmed valve implantation: increase of corrected visual acuity by 34%, stabilization of initially elevated IOP by 100%. The baseline IOP of 29.9±6.6 mm Hg decreased to 9.7±3.6 mm Hg (p<0.05). The better visual results can be attributed to the reduced incidence of hyphema as a result of preoperative anti-VEGF therapy, which simplifies the surgical procedure. In addition, preoperative intravitreal injection of ranibizumab (IVI) improved best corrected visual acuity by relieving macular edema. Our study shows that the combination of Ahmed valve implantation and intravitreal injection of an anti-VEGF agent is successful in the early follow-up period, but fails to persist: an increase in IOP to almost 21 mm Hg was seen in both groups by the end of one-year follow-up, and visual acuity regressed in group 2.CONCLUSION. The use of anti-VEGF agent prior to Ahmed valve implantation provides better functional outcomes in the early postoperative period. Intravitreal administration of ranibizumab prior to Ahmed valve implantation minimizes the number of hemorrhagic complications in the early postoperative period and reduces the length of hospital stay. Within one year after surgery, patients experienced regression of visual acuity, as well as an increase in intraocular hypertension following the reactivation of iris neovascularization.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"218 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122390284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.53432/2078-4104-2022-21-4-3-12
V. Kotelin, M. Zueva, N. Balatskaya, S. Petrov, A. Zhuravleva, I. Tsapenko
PURPOSE. To study the correlations between the immunological data and the indicators of electroretinography (ERG) and optical coherence tomography (OCT) in patients with advanced stages of primary open-angle glaucoma (POAG).METHODS. Previously, we conducted a multimodal study of patients with advanced stages of glaucoma involving ERG, morphometric and immunological studies. In this new study we performed a correlation analysis of the immunological and morphofunctional data of patients with advanced stages of POAG. The study included 35 patients (35 eyes), among them 19 women and 16 men, who were divided into two groups: group 1 — stage II POAG (12 patients, 12 eyes), and group 2 — stage III POAG (23 patients, 23 eyes). The average age of the subjects was 64.2±6.5 years. Intraocular pressure was compensated in all study patients. The Pearson's correlation coefficient was used to calculate the linear relationship between continuous features.RESULTS. In the subgroup with stage II POAG significant correlations of moderate strength (according to the Chaddock scale) were found between the parameters of pattern ERG (PERG) and photopic negative response (PhNR) and the level of VEGF-A in the blood serum (BS), EGF in the tear fluid (TF) and aqueous humor (AH); strong correlations — for the concentrations of EGF and TGF-β2 in the AH. In group 2, moderate correlations between PERG and PhNR parameters and the level of IL-1RA in the TF were found, as well as moderate correlation of TGF-β2 expression in the AH with PnHR amplitude from the baseline. In patients with stage II glaucoma, the levels of MIP-1β/CCL4 in the TF, IL-1RA in the intraocular fluid correlated with the thickness of the retinal nerve fiber layer (RNFL) and retinal ganglion cell layer (GCL), while the EGF in the TF and AH correlated with RNFL thickness. In the group with stage III POAG, correlations of moderate strength were found for the expression level of TNF-α, IL-8/CXCL8 in the TF and RNFL thickness, and strong correlations — for the level of IP-10/CXCL10, HGF/SF, TGF-β2 in AH and the thickness of RNFL and GCL.CONCLUSION. Comparison of ERG, OCT findings and the level of cytokines of various biological effects in the BS, TF and AH confirmed the high informativeness of PERG and PhNR indicators and immunological data as markers of advanced stages of POAG, and allow EGF to be considered as the most promising pathogenetically oriented immunological marker of II and III stages of glaucoma.
{"title":"Correlation analysis of morphofunctional and immunological parameters in patients with advanced stages of primary open-angle glaucoma","authors":"V. Kotelin, M. Zueva, N. Balatskaya, S. Petrov, A. Zhuravleva, I. Tsapenko","doi":"10.53432/2078-4104-2022-21-4-3-12","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-4-3-12","url":null,"abstract":"PURPOSE. To study the correlations between the immunological data and the indicators of electroretinography (ERG) and optical coherence tomography (OCT) in patients with advanced stages of primary open-angle glaucoma (POAG).METHODS. Previously, we conducted a multimodal study of patients with advanced stages of glaucoma involving ERG, morphometric and immunological studies. In this new study we performed a correlation analysis of the immunological and morphofunctional data of patients with advanced stages of POAG. The study included 35 patients (35 eyes), among them 19 women and 16 men, who were divided into two groups: group 1 — stage II POAG (12 patients, 12 eyes), and group 2 — stage III POAG (23 patients, 23 eyes). The average age of the subjects was 64.2±6.5 years. Intraocular pressure was compensated in all study patients. The Pearson's correlation coefficient was used to calculate the linear relationship between continuous features.RESULTS. In the subgroup with stage II POAG significant correlations of moderate strength (according to the Chaddock scale) were found between the parameters of pattern ERG (PERG) and photopic negative response (PhNR) and the level of VEGF-A in the blood serum (BS), EGF in the tear fluid (TF) and aqueous humor (AH); strong correlations — for the concentrations of EGF and TGF-β2 in the AH. In group 2, moderate correlations between PERG and PhNR parameters and the level of IL-1RA in the TF were found, as well as moderate correlation of TGF-β2 expression in the AH with PnHR amplitude from the baseline. In patients with stage II glaucoma, the levels of MIP-1β/CCL4 in the TF, IL-1RA in the intraocular fluid correlated with the thickness of the retinal nerve fiber layer (RNFL) and retinal ganglion cell layer (GCL), while the EGF in the TF and AH correlated with RNFL thickness. In the group with stage III POAG, correlations of moderate strength were found for the expression level of TNF-α, IL-8/CXCL8 in the TF and RNFL thickness, and strong correlations — for the level of IP-10/CXCL10, HGF/SF, TGF-β2 in AH and the thickness of RNFL and GCL.CONCLUSION. Comparison of ERG, OCT findings and the level of cytokines of various biological effects in the BS, TF and AH confirmed the high informativeness of PERG and PhNR indicators and immunological data as markers of advanced stages of POAG, and allow EGF to be considered as the most promising pathogenetically oriented immunological marker of II and III stages of glaucoma.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129122894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.53432/2078-4104-2022-21-4-13-21
T. Iureva, J. V. Malysheva, J. V. Kursakova, E. V. Muskatina
PURPOSE. To determine the role of extracellular matrix (ECM), transforming growth factor β (TGF-β) and matrix metalloproteinase 9 (MMP-9) in the mechanisms of filtering bleb formation after non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG).METHODS. The study consisted of prospective examination of 65 patients with POAG operated by the NPDS method. Three groups were formed: group 1 — optimal hypotensive effect of NPDS (21 patients); group 2 — relative hypotensive effect (23 people); group 3 — absence of hypotensive effect (21 patients). During the postoperative period, the condition of the intraocular fluid outflow pathways was evaluated with ultra biomicroscopy, optical coherence tomography, level of intraocular pressure, as well as the concentrations of TGF-β and MMR-9 in the tear and aqueous humor.RESULTS. The anterior chamber aqueous humor was found to contain TGF-β in all patients with glaucoma. Group 1 was noted to have minimal initial TGF-β concentrations in the tear and aqueous humor, high MMR-9 level in the pre- and postoperative period. Sparse extracellular matrix was the substrate for the filtering blebs. Group 2 was revealed to have elevated initial concentrations of TGF-β in the tear and aqueous humor, extremely high level of MMP-9 in the aqueous humor, accumulation of MMP-9 in the tear after 2 weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early period, loci of rigid ECM were visualized in the filtering blebs, but functional outflow pathways were successfully formed by month two after additional therapy. Group 3 was established to have maximum TGF-β concentrations and low MMP-9 concentrations in the anterior chamber aqueous humor, a decrease in tear MMP-9 after two weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early postoperative period, the filtering blebs were based on rigid ECM, by month two there was scar deformation of the outflow pathways.CONCLUSION. The important conditions for the formation of functional filtering blebs after NPDS are the structural organization of temporary ECM of the filtering blebs in the early postoperative period and the timely degradation of ECM components with predominant concentration of MMR-9 over TGF-β.
{"title":"Some aspects of filtering bleb formation in patients with primary open-angle glaucoma after non-penetrating deep sclerectomy","authors":"T. Iureva, J. V. Malysheva, J. V. Kursakova, E. V. Muskatina","doi":"10.53432/2078-4104-2022-21-4-13-21","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-4-13-21","url":null,"abstract":"PURPOSE. To determine the role of extracellular matrix (ECM), transforming growth factor β (TGF-β) and matrix metalloproteinase 9 (MMP-9) in the mechanisms of filtering bleb formation after non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG).METHODS. The study consisted of prospective examination of 65 patients with POAG operated by the NPDS method. Three groups were formed: group 1 — optimal hypotensive effect of NPDS (21 patients); group 2 — relative hypotensive effect (23 people); group 3 — absence of hypotensive effect (21 patients). During the postoperative period, the condition of the intraocular fluid outflow pathways was evaluated with ultra biomicroscopy, optical coherence tomography, level of intraocular pressure, as well as the concentrations of TGF-β and MMR-9 in the tear and aqueous humor.RESULTS. The anterior chamber aqueous humor was found to contain TGF-β in all patients with glaucoma. Group 1 was noted to have minimal initial TGF-β concentrations in the tear and aqueous humor, high MMR-9 level in the pre- and postoperative period. Sparse extracellular matrix was the substrate for the filtering blebs. Group 2 was revealed to have elevated initial concentrations of TGF-β in the tear and aqueous humor, extremely high level of MMP-9 in the aqueous humor, accumulation of MMP-9 in the tear after 2 weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early period, loci of rigid ECM were visualized in the filtering blebs, but functional outflow pathways were successfully formed by month two after additional therapy. Group 3 was established to have maximum TGF-β concentrations and low MMP-9 concentrations in the anterior chamber aqueous humor, a decrease in tear MMP-9 after two weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early postoperative period, the filtering blebs were based on rigid ECM, by month two there was scar deformation of the outflow pathways.CONCLUSION. The important conditions for the formation of functional filtering blebs after NPDS are the structural organization of temporary ECM of the filtering blebs in the early postoperative period and the timely degradation of ECM components with predominant concentration of MMR-9 over TGF-β.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114999147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.53432/2078-4104-2022-21-4-22-28
I. Ioshin, A. Tolchinskaya, A. V. Rakova, I. Maksimov
PURPOSE. To evaluate the capabilities of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with early stages of glaucoma.METHODS. The study included 38 patients with early stages of primary open-angle glaucoma who underwent MP-TSCPC with SUPRA 810 (“Quantel Medical”, France) as primary surgical treatment. The follow-up period averaged 17±11 months (from 6 to 30 months). The Kaplan-Meier scale was used to assess the cumulative success of laser treatment.RESULTS. The postoperative period was uneventful. One month after MP-TSCPC a significant hypotensive effect was observed, averaging 41.5% from the baseline. After 6 months, the hypotensive effect continued to persist and averaged 36.1%. By 12 months, the hypotensive effect remained stable, IOP averaged 16.0±3.5 mm Hg, which was 31% from the baseline. No changes in best corrected visual acuity (BCVA) were detected during the observation period. Target intraocular pressure (IOP) was achieved in all cases. Optical coherence tomography and perimetry findings remained stable or improved.CONCLUSION. MP-TSCPC in patients with early stages of glaucoma leads to a pronounced stable hypotensive effect during the follow-up period, averaging 31% (from 20% to 50%). An improvement in the quality of life was noted due to the cease or reduction in the number of instillations. Monitoring of patients continues in order to develop practical recommendations for the indications and regimens of MP-TSCPC in the early stages of glaucoma.
目的。评价微脉冲经巩膜光凝(MP-TSCPC)治疗早期青光眼的疗效。该研究纳入了38例早期原发性开角型青光眼患者，这些患者采用SUPRA 810(“Quantel Medical”，France)作为主要手术治疗，接受MP-TSCPC。随访时间平均17±11个月(6 ~ 30个月)。Kaplan-Meier量表用于评估激光治疗的累积成功。术后顺利。MP-TSCPC后1个月观察到明显的降压效果，平均比基线低41.5%。6个月后，降压效果持续存在，平均为36.1%。12个月时，降压效果保持稳定，IOP平均为16.0±3.5 mm Hg，较基线下降31%。观察期间最佳矫正视力(BCVA)无变化。所有病例均达到目标眼压(IOP)。光学相干层析成像和视野检查结果保持稳定或有所改善。MP-TSCPC在早期青光眼患者中的降压效果在随访期间显著稳定，平均为31%(从20%到50%)。由于停止或减少了注射次数，生活质量得到了改善。继续对患者进行监测，以便就MP-TSCPC在青光眼早期的适应症和方案提出实用建议。
{"title":"Results of micropulse cyclophotocoagulation in patients with early stages of primary open-angle glaucoma","authors":"I. Ioshin, A. Tolchinskaya, A. V. Rakova, I. Maksimov","doi":"10.53432/2078-4104-2022-21-4-22-28","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-4-22-28","url":null,"abstract":"PURPOSE. To evaluate the capabilities of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with early stages of glaucoma.METHODS. The study included 38 patients with early stages of primary open-angle glaucoma who underwent MP-TSCPC with SUPRA 810 (“Quantel Medical”, France) as primary surgical treatment. The follow-up period averaged 17±11 months (from 6 to 30 months). The Kaplan-Meier scale was used to assess the cumulative success of laser treatment.RESULTS. The postoperative period was uneventful. One month after MP-TSCPC a significant hypotensive effect was observed, averaging 41.5% from the baseline. After 6 months, the hypotensive effect continued to persist and averaged 36.1%. By 12 months, the hypotensive effect remained stable, IOP averaged 16.0±3.5 mm Hg, which was 31% from the baseline. No changes in best corrected visual acuity (BCVA) were detected during the observation period. Target intraocular pressure (IOP) was achieved in all cases. Optical coherence tomography and perimetry findings remained stable or improved.CONCLUSION. MP-TSCPC in patients with early stages of glaucoma leads to a pronounced stable hypotensive effect during the follow-up period, averaging 31% (from 20% to 50%). An improvement in the quality of life was noted due to the cease or reduction in the number of instillations. Monitoring of patients continues in order to develop practical recommendations for the indications and regimens of MP-TSCPC in the early stages of glaucoma.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129815743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.53432/2078-4104-2022-21-4-29-35
E. Stepanova, O. I. Lebedev
PURPOSE. To determine the types of reaction to pilocarpine in patients with low-tension glaucoma (LTG) and study the nature of fluid outflow along the main pathways in different types of reaction to pilocarpine.METHODS. The observation group included 21 people (42 eyes) with LTG aged 51 to 80 years (average age 68±9.8 years). The criteria for inclusion in the study were emmetropic refraction and no previous laser and surgical interventions on the examined eye. The anterior chamber angle corresponded to medium–wide or wide according to the classification by A.P. Nesterov. The initial stage of LTG was established in 16 eyes, developed stage — 12 eyes, advanced stage — 14 eyes.The examination was carried out both in patients with newly diagnosed glaucoma and in patients with previously established diagnosis who received hypotensive drug therapy; in the latter case the patients were recommended to cease instillations of hypotensive drugs 10–14 days prior to the examination.RESULTS. Among the studied LTG patients, positive pilocarpine test was registered in 5 eyes (12%), negative — in 6 eyes (14%), and paradoxical — in 31 eyes (74%).The obtained data revealed no statistically significant differences in the initial values of anterior chamber depth, lens thickness and axial eye length between patients with paradoxical and positive reactions to pilocarpine. Therefore, there are no anatomical prerequisites for the development of a particular type of reaction to the pilocarpine test in the studied eyes.The ease of outflow coefficient (EOC) for the drainage pathway is significantly reduced in patients with positive reaction to pilocarpine, which in absolute numbers approaches normal values. In these patients the drainage outflow reserves are preserved.In persons with paradoxical reaction to pilocarpine, EOC for the drainage pathway is significantly reduced and is low in absolute numbers. Deterioration of the outflow along the uveoscleral pathway in pilocarpine instillations leads to elevated intraocular pressure.CONCLUSION. The majority of patients with low-tension glaucoma have a paradoxical reaction to the pilocarpine test. The sufficiently high sensitivity of the sample allows recommending it as a diagnostic test for this type of glaucoma.Different types of reaction to pilocarpine in patients with low-tension glaucoma are associated with the intensity of intraocular fluid outflow over the drainage and uveoscleral pathways.
{"title":"Types of reaction to pilocarpine in patients with low-tension glaucoma","authors":"E. Stepanova, O. I. Lebedev","doi":"10.53432/2078-4104-2022-21-4-29-35","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-4-29-35","url":null,"abstract":"PURPOSE. To determine the types of reaction to pilocarpine in patients with low-tension glaucoma (LTG) and study the nature of fluid outflow along the main pathways in different types of reaction to pilocarpine.METHODS. The observation group included 21 people (42 eyes) with LTG aged 51 to 80 years (average age 68±9.8 years). The criteria for inclusion in the study were emmetropic refraction and no previous laser and surgical interventions on the examined eye. The anterior chamber angle corresponded to medium–wide or wide according to the classification by A.P. Nesterov. The initial stage of LTG was established in 16 eyes, developed stage — 12 eyes, advanced stage — 14 eyes.The examination was carried out both in patients with newly diagnosed glaucoma and in patients with previously established diagnosis who received hypotensive drug therapy; in the latter case the patients were recommended to cease instillations of hypotensive drugs 10–14 days prior to the examination.RESULTS. Among the studied LTG patients, positive pilocarpine test was registered in 5 eyes (12%), negative — in 6 eyes (14%), and paradoxical — in 31 eyes (74%).The obtained data revealed no statistically significant differences in the initial values of anterior chamber depth, lens thickness and axial eye length between patients with paradoxical and positive reactions to pilocarpine. Therefore, there are no anatomical prerequisites for the development of a particular type of reaction to the pilocarpine test in the studied eyes.The ease of outflow coefficient (EOC) for the drainage pathway is significantly reduced in patients with positive reaction to pilocarpine, which in absolute numbers approaches normal values. In these patients the drainage outflow reserves are preserved.In persons with paradoxical reaction to pilocarpine, EOC for the drainage pathway is significantly reduced and is low in absolute numbers. Deterioration of the outflow along the uveoscleral pathway in pilocarpine instillations leads to elevated intraocular pressure.CONCLUSION. The majority of patients with low-tension glaucoma have a paradoxical reaction to the pilocarpine test. The sufficiently high sensitivity of the sample allows recommending it as a diagnostic test for this type of glaucoma.Different types of reaction to pilocarpine in patients with low-tension glaucoma are associated with the intensity of intraocular fluid outflow over the drainage and uveoscleral pathways.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115731251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.53432/2078-4104-2022-21-4-56-63
A. Movsisyan, A. Egorov, A. Kuroyedov
The trends of recent years regarding the surgical treatment of the visual organ and its appendages are to minimize tissue traumatization during surgical manipulations, reduce their duration, as well as achieve the best possible outcome from the points of view of the doctor and the patient at minimal economic costs. Currently, the leading vector in glaucoma treatment remains the achievement of the target level of intraocular pressure (IOP). Taking into account the projected increase in the number of patients with glaucoma, conducting justified surgical treatment will remain relevant in the future. Its present state prompts the creation of new drugs, new means of their delivery, and surgical techniques with improved safety profile while achieving effective IOP reduction. In this regard, the trends in the development of surgical treatment of glaucoma have shifted towards procedures with minimal trauma to the eye tissues — minimally invasive glaucoma surgery (MIGS). The article discusses modern varieties of MIGS, theoretical and practical aspects of their application (effectiveness and safety profile), as well as prospects of their use.
{"title":"Effectiveness of minimally invasive glaucoma surgery (review of international experience)","authors":"A. Movsisyan, A. Egorov, A. Kuroyedov","doi":"10.53432/2078-4104-2022-21-4-56-63","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-4-56-63","url":null,"abstract":"The trends of recent years regarding the surgical treatment of the visual organ and its appendages are to minimize tissue traumatization during surgical manipulations, reduce their duration, as well as achieve the best possible outcome from the points of view of the doctor and the patient at minimal economic costs. Currently, the leading vector in glaucoma treatment remains the achievement of the target level of intraocular pressure (IOP). Taking into account the projected increase in the number of patients with glaucoma, conducting justified surgical treatment will remain relevant in the future. Its present state prompts the creation of new drugs, new means of their delivery, and surgical techniques with improved safety profile while achieving effective IOP reduction. In this regard, the trends in the development of surgical treatment of glaucoma have shifted towards procedures with minimal trauma to the eye tissues — minimally invasive glaucoma surgery (MIGS). The article discusses modern varieties of MIGS, theoretical and practical aspects of their application (effectiveness and safety profile), as well as prospects of their use.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"360 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125650942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-30DOI: 10.53432/2078-4104-2022-21-3-64-71
I. Isakov, A. Kuroyedov
To date, there have been no studies in the Russian Federation analyzing the territorial prevalence of secondary glaucoma (SG). The reasons for this lie in the specifics of providing epidemiological reports on the incidence of this pathology, staff shortage in the budgetary health care system, lack of clinical interest of researchers in thisт form of the disease, for example due to the severity of its course, etc. At the same time, secondary glaucoma is one of the most severe glaucoma forms, which tends to progress and is difficult to treat with drugs or surgery. The high occurrence of SG (6–22%) worldwide and the risk of losing visual function make it important to continue studying this pathology. The varying occurrence of SG is determined by numerous factors, such as etiology of the disease, demographic and territorial features of the region, educational level, cultural and economic characteristics, patients' awareness and competence. The level of ophthalmologic services, such as qualification of the attending physicians, and the types of glaucoma surgeries that can be performed in the region also play an important role. Considering the relevance of this problem, the aim of this literature review is to determine the epidemiological characteristics of the disease in patients with secondary glaucoma.
{"title":"The profile of patients with secondary glaucoma","authors":"I. Isakov, A. Kuroyedov","doi":"10.53432/2078-4104-2022-21-3-64-71","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-64-71","url":null,"abstract":" To date, there have been no studies in the Russian Federation analyzing the territorial prevalence of secondary glaucoma (SG). The reasons for this lie in the specifics of providing epidemiological reports on the incidence of this pathology, staff shortage in the budgetary health care system, lack of clinical interest of researchers in thisт form of the disease, for example due to the severity of its course, etc. At the same time, secondary glaucoma is one of the most severe glaucoma forms, which tends to progress and is difficult to treat with drugs or surgery. The high occurrence of SG (6–22%) worldwide and the risk of losing visual function make it important to continue studying this pathology. The varying occurrence of SG is determined by numerous factors, such as etiology of the disease, demographic and territorial features of the region, educational level, cultural and economic characteristics, patients' awareness and competence. The level of ophthalmologic services, such as qualification of the attending physicians, and the types of glaucoma surgeries that can be performed in the region also play an important role. Considering the relevance of this problem, the aim of this literature review is to determine the epidemiological characteristics of the disease in patients with secondary glaucoma.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128929043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-30DOI: 10.53432/2078-4104-2022-21-3-58-63
I. G. Ovechkin, N. I. Ovechkin, D. F. Pokrovsky, A. I. Pavlov, А. V. Shakula
Improving the methodology for assessment of the "quality of life" (QoL) of patients in ophthalmic practice is a regular process aimed at increasing the efficiency of clinical diagnostic examination. An analysis of how the quality of life assessment methodology is being improved in the practice of foreign ophthalmologists reveals two interrelated areas — the introduction of various methods of mathematical analysis in order to confirm the content and constructive validity of the developed questionnaire, as well as the wider distribution of approved questionnaires based on adaptation to a specific state language. The accumulated experience of the authors indicates that the involvement (as experts) of ophthalmologists in the development of a QоL questionnaire, as well as the optimal procedure for scaling patient responses, are effective ways to improve the methodology for assessing QoL, which is confirmed by an assessment of the original QoL questionnaires designed for patients with vitreoretinal pathologies, computer vision syndrome and cataracts.
{"title":"Ways to improve the assessment of the \"quality of life\" in ophthalmology patients — world trends and own experience","authors":"I. G. Ovechkin, N. I. Ovechkin, D. F. Pokrovsky, A. I. Pavlov, А. V. Shakula","doi":"10.53432/2078-4104-2022-21-3-58-63","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-58-63","url":null,"abstract":" Improving the methodology for assessment of the \"quality of life\" (QoL) of patients in ophthalmic practice is a regular process aimed at increasing the efficiency of clinical diagnostic examination. An analysis of how the quality of life assessment methodology is being improved in the practice of foreign ophthalmologists reveals two interrelated areas — the introduction of various methods of mathematical analysis in order to confirm the content and constructive validity of the developed questionnaire, as well as the wider distribution of approved questionnaires based on adaptation to a specific state language. The accumulated experience of the authors indicates that the involvement (as experts) of ophthalmologists in the development of a QоL questionnaire, as well as the optimal procedure for scaling patient responses, are effective ways to improve the methodology for assessing QoL, which is confirmed by an assessment of the original QoL questionnaires designed for patients with vitreoretinal pathologies, computer vision syndrome and cataracts.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125837508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-30DOI: 10.53432/2078-4104-2022-21-3-72-84
M. Kats, A. Kuroyedov
Current statistics show that glaucoma is the main cause of irreversible blindness worldwide. This fact generates continued interest in the search for new methods of rapid and accurate diagnosis of the disease. Presently, reducing the level of intra-ocular pressure (IOP) is the only proven strategy for slowing the progression of glaucomatous optic neuropathy. As such, achieving the so-called «target» pressure is the aim of any effective anti-glaucoma therapy. However, as practice shows, compensation of IOP does not always lead to stabilization of glaucoma progression. The concept of determining the «target» level of IOP implies a percentage decrease calculated by formulas, or a predetermined value, or a range of values. However, none of these strategies are considered as the leading one. The definition of «target pressure» is multifaceted and requires attention to many different factors. In addition, the understanding of how the level of IOP affects the progression of glaucoma is constantly evolving. In this review we summarize the data on the concept of «target» IOP, as well as on various concepts of achieving it.
{"title":"On the optimal values of «target» intraocular pressure","authors":"M. Kats, A. Kuroyedov","doi":"10.53432/2078-4104-2022-21-3-72-84","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-72-84","url":null,"abstract":" Current statistics show that glaucoma is the main cause of irreversible blindness worldwide. This fact generates continued interest in the search for new methods of rapid and accurate diagnosis of the disease. Presently, reducing the level of intra-ocular pressure (IOP) is the only proven strategy for slowing the progression of glaucomatous optic neuropathy. As such, achieving the so-called «target» pressure is the aim of any effective anti-glaucoma therapy. However, as practice shows, compensation of IOP does not always lead to stabilization of glaucoma progression. The concept of determining the «target» level of IOP implies a percentage decrease calculated by formulas, or a predetermined value, or a range of values. However, none of these strategies are considered as the leading one. The definition of «target pressure» is multifaceted and requires attention to many different factors. In addition, the understanding of how the level of IOP affects the progression of glaucoma is constantly evolving. In this review we summarize the data on the concept of «target» IOP, as well as on various concepts of achieving it.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"281 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116077640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-30DOI: 10.53432/2078-4104-2022-21-3-42-48
V. Erichev, V. S. Zinina, A. V. Volzhanin
PURPOSE. To compare hypotensive efficiency and safety of generic latanoprost 0.005 % (Glaumax, “KEVELT AS”, Estonia) and original latanoprost 0.005 % (Xalatan, “Pfizer Inc”, USA) in glaucoma patients. METHODS. The study included patients with newly diagnosed primary open-angle glaucoma or patients with primary open-angle glaucoma on carbonic anhydrase inhibitor monotherapy 4 days after cease of treatment (the “wash-out” period). Study patients were divided into 2 groups. Group 1 consisted of 25 patients (30 eyes) with initial and advanced stages of newly diagnosed POAG and initial corneal-compensated IOP (IOPcc) of 25.15 ± 1.48 mm Hg. This group of patients was prescribed instillations of 0.005 % Glaumax eye drops 1 time per day. Group 2 also included 25 patients (30 eyes) with initial stage of newly diagnosed POAG and initial corneal-compensated IOP (IOPcc) of 25.08 ± 1.42 mm Hg. Group 2 patients were prescribed instillations of 0.005 % Xalatan eye drops 1 time per day. IOPcc was measured initially after the washout period, then 1 and 2 months after the start of the new therapy. Additionally, all patients were assessed for tear film break up time (Norn’s test) at each follow-up point. RESULTS. After 1 month, IOPcc in groups 1 and 2 was 17.36 ± 1.39 and 18.09 ± 1.45 mm Hg, respectively; after 2 month, 17.87 ± 1.30 and 18.54 mm Hg, respectively. The Norn’s test results in groups 1 and 2 after 1 month were 8 (7; 9.75) and 8 (6; 9.75) seconds, after 2 months it was 8.5 (8; 9) and 8 (7; 10) seconds, respectively, which corresponded to the initial stage of the "dry eye" syndrome. No statistically significant intergroup differences were found in any of the cases. CONCLUSION. Xalatan 0.005 and Glaumax 0.005 have comparable efficacy and tolerability, and both help achieve persistent stabilization of IOP. The option for a single-instillation regimen is convenient for the patients.
目的。比较0.005%仿制药拉坦前列素(Glaumax，“KEVELT AS”，爱沙尼亚)和0.005%原药拉坦前列素(Xalatan，“辉瑞公司”，美国)在青光眼患者中的降压效果和安全性。方法。该研究纳入了新诊断的原发性开角型青光眼患者或停止治疗4天后接受碳酸酐酶抑制剂单药治疗的原发性开角型青光眼患者(“洗脱期”)。研究患者分为两组。第一组25例(30只眼)初、晚期新诊断POAG，初始角膜代偿IOP (IOPcc)为25.15±1.48 mm Hg，给予0.005% Glaumax滴眼液，每日1次。2组25例(30眼)为初诊POAG，初始角膜代偿IOP (IOPcc)为25.08±1.42 mm Hg，给予0.005% Xalatan滴眼液，每日1次。IOPcc最初在洗脱期后测量，然后在新疗法开始后1个月和2个月测量。此外，在每个随访点评估所有患者的泪膜破裂时间(Norn试验)。结果。1个月后，1组和2组的IOPcc分别为17.36±1.39和18.09±1.45 mm Hg;2个月后分别为17.87±1.30 mm Hg和18.54 mm Hg。1、2组患者1个月后Norn 's试验结果为8 (7;9.75)和8 (6);9.75)秒，2个月后为8.5 (8;9)和8 (7);10)秒，这与“干眼”综合征的初始阶段相对应。在任何病例中均未发现统计学上显著的组间差异。结论。Xalatan 0.005和Glaumax 0.005的疗效和耐受性相当，都有助于实现IOP的持续稳定。单次注射方案的选择对患者来说是方便的。
{"title":"Comparative study of the efficacy and safety of 0.005 % Glaumax and 0.005 % Xalatan","authors":"V. Erichev, V. S. Zinina, A. V. Volzhanin","doi":"10.53432/2078-4104-2022-21-3-42-48","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-42-48","url":null,"abstract":" PURPOSE. To compare hypotensive efficiency and safety of generic latanoprost 0.005 % (Glaumax, “KEVELT AS”, Estonia) and original latanoprost 0.005 % (Xalatan, “Pfizer Inc”, USA) in glaucoma patients. METHODS. The study included patients with newly diagnosed primary open-angle glaucoma or patients with primary open-angle glaucoma on carbonic anhydrase inhibitor monotherapy 4 days after cease of treatment (the “wash-out” period). Study patients were divided into 2 groups. Group 1 consisted of 25 patients (30 eyes) with initial and advanced stages of newly diagnosed POAG and initial corneal-compensated IOP (IOPcc) of 25.15 ± 1.48 mm Hg. This group of patients was prescribed instillations of 0.005 % Glaumax eye drops 1 time per day. Group 2 also included 25 patients (30 eyes) with initial stage of newly diagnosed POAG and initial corneal-compensated IOP (IOPcc) of 25.08 ± 1.42 mm Hg. Group 2 patients were prescribed instillations of 0.005 % Xalatan eye drops 1 time per day. IOPcc was measured initially after the washout period, then 1 and 2 months after the start of the new therapy. Additionally, all patients were assessed for tear film break up time (Norn’s test) at each follow-up point. RESULTS. After 1 month, IOPcc in groups 1 and 2 was 17.36 ± 1.39 and 18.09 ± 1.45 mm Hg, respectively; after 2 month, 17.87 ± 1.30 and 18.54 mm Hg, respectively. The Norn’s test results in groups 1 and 2 after 1 month were 8 (7; 9.75) and 8 (6; 9.75) seconds, after 2 months it was 8.5 (8; 9) and 8 (7; 10) seconds, respectively, which corresponded to the initial stage of the \"dry eye\" syndrome. No statistically significant intergroup differences were found in any of the cases. CONCLUSION. Xalatan 0.005 and Glaumax 0.005 have comparable efficacy and tolerability, and both help achieve persistent stabilization of IOP. The option for a single-instillation regimen is convenient for the patients.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130707551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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