Pub Date : 2022-08-30DOI: 10.53432/2078-4104-2022-21-3-49-56
E. Ivachev
The comorbidity of glaucoma and cataract occurs in up to 76 % of ophthalmic patients. The presence of glaucoma in these patients increases the risk of complications in cataract surgery by up to 51.6%. Small pupil occurs in 14 % of cases during cataract surgery, with frequency increasing with age, reaching 71% by the age of 80. Small pupil is a complicating factor in phacoemulsification in patients with glaucoma and can lead to undesirable visual outcomes. However, today the arsenal of ophthalmic surgeons has a number of iris retractors that dilate the pupil during the lens extraction, which makes the operation simpler. Weakness of the ligamentous apparatus of the lens occurs in one third of patients with glaucoma. Cataract surgery in these patients is accompanied by difficulties in performing classical capsulorhexis and a high risk of decentration or subluxation of the lens. Pupil rigidity, drug-induced miosis and ligamentous laxity require the use of iris retractors, capsular rings, and in some cases extracapsular fixation of the lens. Hemorrhagic complications of cataract surgery in patients with glaucoma manifest as hyphema and expulsive hemorrhages. Considering the specifics of ocular microcirculation, expulsive hemorrhage occurs during cataract surgery in 0.026–0.04 % of cases. The reason for this is the difference in pressure in the vascular bed and out-side of it. The higher the initial intraocular pressure during lens extraction, the higher the risk of hemorrhage. The conventional recommendation is maximum compensation of intraocular pressure before phacoemulsification.
{"title":"Features of cataract surgery and the postoperative period in patients with glaucoma (part 1)","authors":"E. Ivachev","doi":"10.53432/2078-4104-2022-21-3-49-56","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-49-56","url":null,"abstract":" The comorbidity of glaucoma and cataract occurs in up to 76 % of ophthalmic patients. The presence of glaucoma in these patients increases the risk of complications in cataract surgery by up to 51.6%. Small pupil occurs in 14 % of cases during cataract surgery, with frequency increasing with age, reaching 71% by the age of 80. Small pupil is a complicating factor in phacoemulsification in patients with glaucoma and can lead to undesirable visual outcomes. However, today the arsenal of ophthalmic surgeons has a number of iris retractors that dilate the pupil during the lens extraction, which makes the operation simpler. Weakness of the ligamentous apparatus of the lens occurs in one third of patients with glaucoma. Cataract surgery in these patients is accompanied by difficulties in performing classical capsulorhexis and a high risk of decentration or subluxation of the lens. Pupil rigidity, drug-induced miosis and ligamentous laxity require the use of iris retractors, capsular rings, and in some cases extracapsular fixation of the lens. Hemorrhagic complications of cataract surgery in patients with glaucoma manifest as hyphema and expulsive hemorrhages. Considering the specifics of ocular microcirculation, expulsive hemorrhage occurs during cataract surgery in 0.026–0.04 % of cases. The reason for this is the difference in pressure in the vascular bed and out-side of it. The higher the initial intraocular pressure during lens extraction, the higher the risk of hemorrhage. The conventional recommendation is maximum compensation of intraocular pressure before phacoemulsification.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"58 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":"126985413","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 : 2022-08-29DOI: 10.53432/2078-4104-2022-21-3-3-9
E. Stepanova, O. I. Lebedev
PURPOSE. To quantify the outflow of intraocular fluid along various pathways depending on the stage of the disease in typical primary open-angle glaucoma (POAG) and low-tension glaucoma (LTG) cases, and compare the obtained results. METHODS. This study involved 30 patients (57 eyes) with POAG at various stages, aged 58 to 80 years old (mean age 67 ± 8.0 years). The comparison group included 33 patients (62 eyes) with LTG at various stages aged 51 to 80 years old (mean age 69 ± 10.4 years). All subjects had no history of previous laser or surgical interventions on the studied eye. The controls were 15 clinically healthy individuals (30 eyes) of the same age group. On the first day, electronic tonography was performed using tonograph TNC- 100-S with a 4-minute recording of the curve. On the next day, tonography was per-formed with simultaneous blockade of the drainage outflow pathway using a perilimbal vacuum — compression ring according to the method by Prof. N.V. Kosykh. RESULTS. The overall ease of outflow coefficient (EOC) in POAG has a pronounced tendency to decrease with stage advancement. Its decrease in the II and III stages of the disease is 35 % and 30 %, respectively. The EOC for the uveoscleral pathway with POAG decreases in the II and III stages of the disease and amounts to 33.3 % and 25 %, respectively. The ratio of uveoscleral outflow in POAG increases by 3.3 % and 6.5 % in the II and III stages, respectively. With stage I and II LTG, this indicator is stable and remains at a fairly high level, and in the III stage it decreases by 33.3 % compared to stage II. The ratio of uveoscleral out-flow in LTG increases by 21 % in the II stage and by 11 % in the III stage of the disease. CONCLUSION. The rate of fluid outflow along the uveoscleral pathway is higher in LTG than in POAG. The ratio of uveoscleral outflow to overall outflow is greater in LTG in comparison with POAG. In this respect, it can be concluded that preservation of IOP within the limits of the average norm in LTG may be associated with a more pronounced function of the uveoscleral outflow pathway.
{"title":"A clinical study of hydrodynamic parameters of the eye in primary open-angle glaucoma and low-tension glaucoma","authors":"E. Stepanova, O. I. Lebedev","doi":"10.53432/2078-4104-2022-21-3-3-9","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-3-9","url":null,"abstract":" PURPOSE. To quantify the outflow of intraocular fluid along various pathways depending on the stage of the disease in typical primary open-angle glaucoma (POAG) and low-tension glaucoma (LTG) cases, and compare the obtained results. METHODS. This study involved 30 patients (57 eyes) with POAG at various stages, aged 58 to 80 years old (mean age 67 ± 8.0 years). The comparison group included 33 patients (62 eyes) with LTG at various stages aged 51 to 80 years old (mean age 69 ± 10.4 years). All subjects had no history of previous laser or surgical interventions on the studied eye. The controls were 15 clinically healthy individuals (30 eyes) of the same age group. On the first day, electronic tonography was performed using tonograph TNC- 100-S with a 4-minute recording of the curve. On the next day, tonography was per-formed with simultaneous blockade of the drainage outflow pathway using a perilimbal vacuum — compression ring according to the method by Prof. N.V. Kosykh. RESULTS. The overall ease of outflow coefficient (EOC) in POAG has a pronounced tendency to decrease with stage advancement. Its decrease in the II and III stages of the disease is 35 % and 30 %, respectively. The EOC for the uveoscleral pathway with POAG decreases in the II and III stages of the disease and amounts to 33.3 % and 25 %, respectively. The ratio of uveoscleral outflow in POAG increases by 3.3 % and 6.5 % in the II and III stages, respectively. With stage I and II LTG, this indicator is stable and remains at a fairly high level, and in the III stage it decreases by 33.3 % compared to stage II. The ratio of uveoscleral out-flow in LTG increases by 21 % in the II stage and by 11 % in the III stage of the disease. CONCLUSION. The rate of fluid outflow along the uveoscleral pathway is higher in LTG than in POAG. The ratio of uveoscleral outflow to overall outflow is greater in LTG in comparison with POAG. In this respect, it can be concluded that preservation of IOP within the limits of the average norm in LTG may be associated with a more pronounced function of the uveoscleral outflow pathway.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114682709","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 : 2022-08-29DOI: 10.53432/2078-4104-2022-21-3-11-16
Z. Surnina, M. V. Karpilova
PURPOSE. T o analyze the course and structure of corneal nerve fibers (CNF) in patients with different stages of primary open-angle glaucoma (POAG), and to determine possible correlations with the available diagnostic indicators of glaucoma progression. METHODS. The study included 48 patients (48 eyes) diagnosed with stages I–IV POAG at the age of 33 to 75 years. In addition to standard examination methods, all patients underwent static perimetry with Humphrey Field Analyzer II, optical coherence tomography (OCT) of the optic disc, measurement of biomechanical properties of the fibrous membrane of the eye, as well as laser confocal microscopy of the cornea on HRT III device with corneal adapter Cornea Rostock. RESULTS. There were positive correlations of medium strength between the indices of basic nerve fiber length (r = 0.64 and r = 0.63; p < 0.05) and density (r = 0.6 and r = 0.65; p < 0.05) with perimetry data (MD and PSD) and retinal nerve fiber thickness measured with OCT of the optic disc (r = 0.65 and r = 0.61; p < 0.05). Nerve fiber anisometry and symmetry coefficients depended on glaucoma stage (r = 0.62 and r = 0.65; p < 0.05). An increase in the number and density of Langerhans cells and an increase in the length of their processes were detected. A reliable correlation (r = 0.63) was found between glaucoma stage and corneal inflammatory response. The immune etiology of the glaucoma process considered by several authors may be a reason of an increase in the number and density of macrophages during the progression of POAG. CONCLUSION. Laser confocal microscopy can be used as an additional diagnostic method for patients with different stages of POAG.
{"title":"Course and structure of corneal nerve fibers in patients with primary open-angle glaucoma","authors":"Z. Surnina, M. V. Karpilova","doi":"10.53432/2078-4104-2022-21-3-11-16","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-11-16","url":null,"abstract":" PURPOSE. T o analyze the course and structure of corneal nerve fibers (CNF) in patients with different stages of primary open-angle glaucoma (POAG), and to determine possible correlations with the available diagnostic indicators of glaucoma progression. METHODS. The study included 48 patients (48 eyes) diagnosed with stages I–IV POAG at the age of 33 to 75 years. In addition to standard examination methods, all patients underwent static perimetry with Humphrey Field Analyzer II, optical coherence tomography (OCT) of the optic disc, measurement of biomechanical properties of the fibrous membrane of the eye, as well as laser confocal microscopy of the cornea on HRT III device with corneal adapter Cornea Rostock. RESULTS. There were positive correlations of medium strength between the indices of basic nerve fiber length (r = 0.64 and r = 0.63; p < 0.05) and density (r = 0.6 and r = 0.65; p < 0.05) with perimetry data (MD and PSD) and retinal nerve fiber thickness measured with OCT of the optic disc (r = 0.65 and r = 0.61; p < 0.05). Nerve fiber anisometry and symmetry coefficients depended on glaucoma stage (r = 0.62 and r = 0.65; p < 0.05). An increase in the number and density of Langerhans cells and an increase in the length of their processes were detected. A reliable correlation (r = 0.63) was found between glaucoma stage and corneal inflammatory response. The immune etiology of the glaucoma process considered by several authors may be a reason of an increase in the number and density of macrophages during the progression of POAG. CONCLUSION. Laser confocal microscopy can be used as an additional diagnostic method for patients with different stages of POAG.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132582977","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 : 2022-08-29DOI: 10.53432/2078-4104-2022-21-3-25-31
S. Petrov, E. A. Suleiman
PURPOSE. To develop a new modified technique of sinus trabeculectomy for the surgical treatment of primary open-angle glaucoma (POAG) aimed at reducing scarring and improving and prolonging the outflow of aqueous humor along newly formed pathways. METHODS. In the course of the surgery, superficial and deep scleral flaps were formed. After trabeculectomy, the lateral edges of the deep flap were turned inside out and superimposed on each other, forming a roller with "grooves" on its sides used for the outflow of aque-ous humor. The operation was performed in 52 patients (52 eyes) aged 43 to 84 years old (mean age 63.4 ± 1.49 years). Of these, 39 patients were diagnosed with POAG at advanced and far advanced stages, and 13 patients with POAG and a history of previous laser and surgical interventions. The patients were divided into groups: group 1 (main) — 25 patients (25 eyes) who underwent the modified sinus trabeculectomy involving the formation of grooves for the outflow of aqueous humor, and group 2 (controls) — 27 patients (27 eyes) who underwent standard sinus trabeculectomy. The follow-up lasted up to 24 months. Standard methods of examination were used (visometry, tonometry, computer perimetry, tonography, etc.). Optical coherence tomography of the anterior segment of the eye was performed in the early postoperative period, followed by ultrasound biomicroscopy. RESULTS. One month after surgery, the average level of intraocular pressure was comparable and remained low in all groups: 1 — 16.7 ± 0.6 mm Hg, 2 — 17.1 ± 0.7 mm Hg. After one year post surgery, IOP remained normalized in both groups. By 24 months, IOP normalization was preserved in 84 %, and including patients compensated on medication — 96 %. In the control group, the hypotensive success rate was 74 %, and including patients compensated on a medication regimen — 88.8 %. CONCLUSION. The newly developed sinus trabeculectomy technique for the surgical treatment of glaucoma achieves a prolonged hypotensive effect.
目的。目的:探讨一种改良的鼻窦小梁切除术治疗原发性开角型青光眼的新技术，旨在减少瘢痕形成，改善和延长房水沿新形成的通道流出。方法。在手术过程中，形成浅层和深层巩膜瓣。小梁切除术后，深层皮瓣的外侧边缘向外翻转，相互叠加，形成一个滚轮，其侧面有“凹槽”，用于房水的流出。手术患者52例(52眼)，年龄43 ~ 84岁，平均年龄63.4±1.49岁。其中，39例患者被诊断为晚期和远晚期POAG, 13例POAG患者有既往激光和手术治疗史。患者被分为两组:第一组(主要)- 25例患者(25眼)接受改良的鼻窦小梁切除术，包括房水流出形成沟槽;第二组(对照组)- 27例患者(27眼)接受标准的鼻窦小梁切除术。随访时间长达24个月。采用标准的检查方法(粘度法、眼压法、计算机视野法、张力法等)。术后早期进行眼前段光学相干断层扫描，然后进行超声生物显微镜检查。结果。术后1个月，两组平均眼压水平相当且保持在较低水平:1 - 16.7±0.6 mm Hg, 2 - 17.1±0.7 mm Hg。术后1年后，两组IOP均恢复正常。到24个月时，84%的IOP恢复正常，包括药物补偿的患者- 96%。在对照组中，降压成功率为74%，包括药物治疗方案补偿的患者- 88.8%。结论。新发展的鼻窦小梁切除术手术治疗青光眼达到长期的降压效果。
{"title":"A new trabeculectomy technique for the treatment of glaucoma","authors":"S. Petrov, E. A. Suleiman","doi":"10.53432/2078-4104-2022-21-3-25-31","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-25-31","url":null,"abstract":" PURPOSE. To develop a new modified technique of sinus trabeculectomy for the surgical treatment of primary open-angle glaucoma (POAG) aimed at reducing scarring and improving and prolonging the outflow of aqueous humor along newly formed pathways. METHODS. In the course of the surgery, superficial and deep scleral flaps were formed. After trabeculectomy, the lateral edges of the deep flap were turned inside out and superimposed on each other, forming a roller with \"grooves\" on its sides used for the outflow of aque-ous humor. The operation was performed in 52 patients (52 eyes) aged 43 to 84 years old (mean age 63.4 ± 1.49 years). Of these, 39 patients were diagnosed with POAG at advanced and far advanced stages, and 13 patients with POAG and a history of previous laser and surgical interventions. The patients were divided into groups: group 1 (main) — 25 patients (25 eyes) who underwent the modified sinus trabeculectomy involving the formation of grooves for the outflow of aqueous humor, and group 2 (controls) — 27 patients (27 eyes) who underwent standard sinus trabeculectomy. The follow-up lasted up to 24 months. Standard methods of examination were used (visometry, tonometry, computer perimetry, tonography, etc.). Optical coherence tomography of the anterior segment of the eye was performed in the early postoperative period, followed by ultrasound biomicroscopy. RESULTS. One month after surgery, the average level of intraocular pressure was comparable and remained low in all groups: 1 — 16.7 ± 0.6 mm Hg, 2 — 17.1 ± 0.7 mm Hg. After one year post surgery, IOP remained normalized in both groups. By 24 months, IOP normalization was preserved in 84 %, and including patients compensated on medication — 96 %. In the control group, the hypotensive success rate was 74 %, and including patients compensated on a medication regimen — 88.8 %. CONCLUSION. The newly developed sinus trabeculectomy technique for the surgical treatment of glaucoma achieves a prolonged hypotensive effect.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115319623","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 : 2022-08-29DOI: 10.53432/2078-4104-2022-21-3-32-40
A. V. Starostina, O. B. Klepinina, A. Sidorova, M. R. Khabazova, A. A. Arisov, K. A. Stefankova
PURPOSE. To evaluate the effectiveness of surgical treatment of secondary glaucoma and to present the clinical features of the postoperative period in a patient with Sturge-Weber syndrome (SWS). METHODS. A patient with SWS, choroidal hemangioma and secondary glaucoma was examined and treated (Ahmed valve implantation) at the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery" in Moscow. RESULTS. Hypotension, a decrease in anterior chamber depth, serous choroidal detachment were observed on the first day after surgery on the left eye. Posterior scleral trepanation and injection of viscoelastic into the anterior chamber was performed. On the next day, IOP normalization and complete choroidal attachment were achieved, but macular detachment of neuroepithelium occurred and was successfully treated with injections of glucocorticosteroids. After one month, the retina and choroid were attached, IOP was 16 mm Hg in the left eye without hypotensive drops, visual acuity was 1.0 in both eyes. CONCLUSION. Implantation of the Ahmed valve can be used in the treatment of secondary glaucoma in patients with SWS in order to reduce the IOP and minimize the risks of complications.
目的。评价手术治疗继发性青光眼的有效性，并介绍一例斯特奇-韦伯综合征(SWS)患者术后的临床特点。方法。1例SWS、脉络膜血管瘤和继发性青光眼患者在莫斯科的S.N. Fedorov国家医学研究中心“MNTK”眼科显微外科接受检查和治疗(Ahmed瓣膜植入)。结果。术后第一天出现低血压、前房深度下降、浆液性脉络膜脱离。后路巩膜钻孔及前房粘弹性注射。第二天，IOP恢复正常，脉络膜完全附着，但黄斑神经上皮脱离，并通过注射糖皮质激素成功治疗。1个月后，视网膜和脉络膜附着，左眼IOP为16 mm Hg，未滴降血压，双眼视力1.0。结论。在SWS患者的继发性青光眼中，可采用Ahmed瓣膜植入术，以降低IOP，减少并发症的发生。
{"title":"Features of the postoperative period after glaucoma surgery in a patient with Sturge-Weber syndrome (clinical case)","authors":"A. V. Starostina, O. B. Klepinina, A. Sidorova, M. R. Khabazova, A. A. Arisov, K. A. Stefankova","doi":"10.53432/2078-4104-2022-21-3-32-40","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-32-40","url":null,"abstract":" PURPOSE. To evaluate the effectiveness of surgical treatment of secondary glaucoma and to present the clinical features of the postoperative period in a patient with Sturge-Weber syndrome (SWS). METHODS. A patient with SWS, choroidal hemangioma and secondary glaucoma was examined and treated (Ahmed valve implantation) at the S.N. Fedorov National Medical Research Center \"MNTK \"Eye Microsurgery\" in Moscow. RESULTS. Hypotension, a decrease in anterior chamber depth, serous choroidal detachment were observed on the first day after surgery on the left eye. Posterior scleral trepanation and injection of viscoelastic into the anterior chamber was performed. On the next day, IOP normalization and complete choroidal attachment were achieved, but macular detachment of neuroepithelium occurred and was successfully treated with injections of glucocorticosteroids. After one month, the retina and choroid were attached, IOP was 16 mm Hg in the left eye without hypotensive drops, visual acuity was 1.0 in both eyes. CONCLUSION. Implantation of the Ahmed valve can be used in the treatment of secondary glaucoma in patients with SWS in order to reduce the IOP and minimize the risks of complications.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"699 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126377575","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 : 2022-08-29DOI: 10.53432/2078-4104-2022-21-3-18-23
E. Stepanova, O. I. Lebedev
PURPOSE. To quantify the content of connective tissue metabolites reflecting the exchange of its main components in biological fluids in low tension glaucoma (LTG) and primary open-angle glaucoma (POAG), and to conduct a comparative analysis of the obtained data. METHODS. The studies were conducted in 33 patients with low tension glaucoma aged 51 to 80 years old (mean age 69 ± 10.4 years), 20 patients with POAG aged 53 to 80 years old (mean age 67 ± 10.1 years) and 15 clinically healthy volunteers aged 52 to 78 years old (mean age 68 ± 9.2 years). The protein components of the fibrous part of the connective tissue were analyzed for daily excretion of oxyproline in urine by the method involving para-Dimethylamin-obenzaldehyde modified by P.N. Sharaev. Serum glycosaminoglycans (GAG) were studied by analyzing carbohydrate components of connective tissue. The concentration of GAG in the blood serum was determined by the colorimetric method, using Dische's carbazole reaction. RESULTS. The amount of GAG in the blood serum of LTG patients was 3.26 ± 1.57 mmol/L, while in the control group consisting of clinically healthy volunteers — 2.92 ± 1.25 mmol/L. The differences were not statistically significant (p > 0.1). The amount of daily excretion of oxyproline in the urine of LTG patients was 17.17 ± 8.64 mmol/day, and in the group of clinically healthy individuals — 13.96 ± 5.61 mmol/day. The differences were statistically significant (p < 0.05). The amount of GAG in the blood serum of POAG patients was 3.97 ± 1.17 mmol/L. The differences in relation to LTG were statistically significant (p < 0.05). The amount of daily excretion of oxyproline in the urine of POAG patients was 32.71 ± 19.79 mmol/day. The differences were statistically significant in relation to LTG (p < 0.05). The amount of GAG and oxyproline in biological fluids tends to increase with the advancement of LTG and POAG. CONCLUSION. Destruction processes in the connective tissue do occur in LTG, but are less pronounced in comparison to POAG and more pronounced in comparison to healthy individuals. The indicator that most clearly reflects the activity of destructive processes in the connective tissue is the daily excretion of oxyproline in urine.
{"title":"A study of connective tissue metabolites in biological fluids of patients with various types of glaucoma","authors":"E. Stepanova, O. I. Lebedev","doi":"10.53432/2078-4104-2022-21-3-18-23","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-3-18-23","url":null,"abstract":" PURPOSE. To quantify the content of connective tissue metabolites reflecting the exchange of its main components in biological fluids in low tension glaucoma (LTG) and primary open-angle glaucoma (POAG), and to conduct a comparative analysis of the obtained data. METHODS. The studies were conducted in 33 patients with low tension glaucoma aged 51 to 80 years old (mean age 69 ± 10.4 years), 20 patients with POAG aged 53 to 80 years old (mean age 67 ± 10.1 years) and 15 clinically healthy volunteers aged 52 to 78 years old (mean age 68 ± 9.2 years). The protein components of the fibrous part of the connective tissue were analyzed for daily excretion of oxyproline in urine by the method involving para-Dimethylamin-obenzaldehyde modified by P.N. Sharaev. Serum glycosaminoglycans (GAG) were studied by analyzing carbohydrate components of connective tissue. The concentration of GAG in the blood serum was determined by the colorimetric method, using Dische's carbazole reaction. RESULTS. The amount of GAG in the blood serum of LTG patients was 3.26 ± 1.57 mmol/L, while in the control group consisting of clinically healthy volunteers — 2.92 ± 1.25 mmol/L. The differences were not statistically significant (p > 0.1). The amount of daily excretion of oxyproline in the urine of LTG patients was 17.17 ± 8.64 mmol/day, and in the group of clinically healthy individuals — 13.96 ± 5.61 mmol/day. The differences were statistically significant (p < 0.05). The amount of GAG in the blood serum of POAG patients was 3.97 ± 1.17 mmol/L. The differences in relation to LTG were statistically significant (p < 0.05). The amount of daily excretion of oxyproline in the urine of POAG patients was 32.71 ± 19.79 mmol/day. The differences were statistically significant in relation to LTG (p < 0.05). The amount of GAG and oxyproline in biological fluids tends to increase with the advancement of LTG and POAG. CONCLUSION. Destruction processes in the connective tissue do occur in LTG, but are less pronounced in comparison to POAG and more pronounced in comparison to healthy individuals. The indicator that most clearly reflects the activity of destructive processes in the connective tissue is the daily excretion of oxyproline in urine.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128687493","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 : 2022-06-01DOI: 10.53432/2078-4104-2022-21-2-51-66
N. Kurysheva, G. Sharova, E. Y. Nekrasova
PURPOSE. To demonstrate the advisability of early lens extraction in the treatment of primary angle closure disease in clinical practice.METHODS. The study presents three clinical cases with patients at different stages of primary angle closure disease (PACD). The first one is related to the development of a bilateral acute attack of primary angle closure (PAC) that happened in the intensive care unit during treatment for acute respiratory distress syndrome (ARDS) associated with COVID-19 pneumonia in a patient with a previously undiagnosed PACD. The second case demonstrates the progression of glaucomatous optic neuropathy (GON) in early primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI) and delayed selective laser trabeculoplasty (SLT) in a patient with increased lens thickness. The third example illustrates the progression of advanced PACG in the right eye (OD) and moderate PACG in the left eye (OS) due to formation of goniosynechiae after bilateral LPI, which required transscleral diode cyclophotocoagulation (TSCP) in OD and trabeculectomy in OS. Subsequently, bilateral cataract phacoemulsification with intraocular lens implantation (CPE+IOL) and SLT were performed.RESULTS. In the first clinical case, advanced PACG developed in both eyes within 2 months. After bilateral LPI, trabeculectomy, compensation of intraocular pressure (IOP) was achieved, visual functions stabilized. In the second clinical case, 5.5 years after LPI and SLT, an increase in the thickness of the lens was revealed (in OD by 0.2 mm, in OS by 0.48 mm). GON did not progress in OD (thinning rate of the retinal nerve fiber layer was 0.94 µm/year, p=0.32) and the progression rate in OS was -1.04 µm/year (p=0.018). Taking into account the lens-involved mechanism of PACD progression, bilateral CPE+IOL was recommended. In the third clinical example, IOP remained elevated after bilateral LPI, TSCP in OD and trabeculectomy in OS as a result of goniosinechiogenesis, and therefore CPE+IOL also did not lead to its decrease. After bilateral SLT, compensation of IOP was achieved without local hypotensive therapy (IOP measured by Icare: OD 18.0 mm Hg, OS 15 mm Hg).CONCLUSION. In order to preserve visual functions, CPE+IOL is highly recommended at the very beginning of PACD, before the formation of GON and goniosynechiae. This is dictated by the dominant role of the lens-involved mechanism in PACD formation, as demonstrated in the described clinical examples.
目的。目的:探讨早期晶状体摘除治疗原发性闭角症的可行性。本文报道3例不同阶段原发性闭角病的临床病例。第一个是在重症监护病房治疗与COVID-19肺炎相关的急性呼吸窘迫综合征(ARDS)期间，一名先前未确诊的PACD患者发生双侧急性原发性闭角发作(PAC)。第二个病例表明，在晶状体厚度增加的患者中，激光周围虹膜切开术(LPI)和延迟选择性激光小梁成形术(SLT)后，早期原发性闭角型青光眼(PACG)患者青光眼视神经病变(GON)的进展。第三个例子说明了由于双侧LPI后眼珠粘连形成的右眼晚期PACG (OD)和左眼中度PACG (OS)的进展，这需要经巩膜二极管环光凝(TSCP)治疗OD和OS的小梁切除术。术后行双侧白内障超声乳化术联合人工晶状体植入术(CPE+IOL)和SLT。在第一例临床病例中，两眼在2个月内出现了晚期PACG。双侧LPI术后，小梁切除术，眼压代偿，视力稳定。第二个临床病例，LPI和SLT后5.5年，晶状体厚度增加(外径增加0.2 mm, OS增加0.48 mm)。视网膜神经纤维层变薄率为0.94µm/年(p= 0.32)， OS的进展率为-1.04µm/年(p=0.018)。考虑到PACD进展与晶状体有关的机制，建议采用双侧CPE+IOL。第三例患者在双侧LPI、OD组TSCP和OS组小梁切除术后IOP仍因孕红素形成而升高，因此CPE+IOL也未导致其降低。在双侧SLT后，IOP得到补偿，无需局部降压治疗(Icare测量IOP: OD 18.0 mm Hg, OS 15 mm Hg)。为了保护视觉功能，强烈建议在PACD初期，GON和goniosynechais形成之前进行CPE+IOL。这是由晶状体相关机制在PACD形成中的主导作用决定的，正如所描述的临床例子所证明的那样。
{"title":"Rationale for early lens extraction in the treatment of primary angle closure disease","authors":"N. Kurysheva, G. Sharova, E. Y. Nekrasova","doi":"10.53432/2078-4104-2022-21-2-51-66","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-2-51-66","url":null,"abstract":"PURPOSE. To demonstrate the advisability of early lens extraction in the treatment of primary angle closure disease in clinical practice.METHODS. The study presents three clinical cases with patients at different stages of primary angle closure disease (PACD). The first one is related to the development of a bilateral acute attack of primary angle closure (PAC) that happened in the intensive care unit during treatment for acute respiratory distress syndrome (ARDS) associated with COVID-19 pneumonia in a patient with a previously undiagnosed PACD. The second case demonstrates the progression of glaucomatous optic neuropathy (GON) in early primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI) and delayed selective laser trabeculoplasty (SLT) in a patient with increased lens thickness. The third example illustrates the progression of advanced PACG in the right eye (OD) and moderate PACG in the left eye (OS) due to formation of goniosynechiae after bilateral LPI, which required transscleral diode cyclophotocoagulation (TSCP) in OD and trabeculectomy in OS. Subsequently, bilateral cataract phacoemulsification with intraocular lens implantation (CPE+IOL) and SLT were performed.RESULTS. In the first clinical case, advanced PACG developed in both eyes within 2 months. After bilateral LPI, trabeculectomy, compensation of intraocular pressure (IOP) was achieved, visual functions stabilized. In the second clinical case, 5.5 years after LPI and SLT, an increase in the thickness of the lens was revealed (in OD by 0.2 mm, in OS by 0.48 mm). GON did not progress in OD (thinning rate of the retinal nerve fiber layer was 0.94 µm/year, p=0.32) and the progression rate in OS was -1.04 µm/year (p=0.018). Taking into account the lens-involved mechanism of PACD progression, bilateral CPE+IOL was recommended. In the third clinical example, IOP remained elevated after bilateral LPI, TSCP in OD and trabeculectomy in OS as a result of goniosinechiogenesis, and therefore CPE+IOL also did not lead to its decrease. After bilateral SLT, compensation of IOP was achieved without local hypotensive therapy (IOP measured by Icare: OD 18.0 mm Hg, OS 15 mm Hg).CONCLUSION. In order to preserve visual functions, CPE+IOL is highly recommended at the very beginning of PACD, before the formation of GON and goniosynechiae. This is dictated by the dominant role of the lens-involved mechanism in PACD formation, as demonstrated in the described clinical examples.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114713588","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 : 2022-06-01DOI: 10.53432/2078-4104-2022-21-2-77-83
E. L. Shalygina, A. Kuroyedov, V. V. Gorodnichy, I. A. Bulakh, O. V. Gaponko, S. V. Diordyichuk, V. Chubar
This review describes currently most well-known research findings dedicated to the specific features of manifestation and course of primary open-angle glaucoma with hereditary tainted history. Despite the fact that aggravated heredity has been confirmed as a risk factor for primary open-angle glaucoma (POAG), the information on the clinical features and progression patterns of POAG in patients with hereditary predisposition presented in the existing publications is scattered, and its availability is still limited by the amount of included material. All of this, in turn, makes it impossible to fully predict the course of the disease and to discuss the possibility of its earlier detection in that population group. The discussion presented in this work points out the type of kinship for which the risk of developing glaucoma is most relevant, as well as the supposed characteristics of the age of onset of POAG among patients with a family history of this disease. The results of the studies analyzed in this review can help actualize the viewpoint on the possible differences in clinical manifestations of the disease in patients with hereditary (familial) and sporadic forms of glaucoma, as well as on the necessity of further clinical research in this area.
{"title":"Clinical features of primary open-angle glaucoma in patients with hereditary tainted family history","authors":"E. L. Shalygina, A. Kuroyedov, V. V. Gorodnichy, I. A. Bulakh, O. V. Gaponko, S. V. Diordyichuk, V. Chubar","doi":"10.53432/2078-4104-2022-21-2-77-83","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-2-77-83","url":null,"abstract":"This review describes currently most well-known research findings dedicated to the specific features of manifestation and course of primary open-angle glaucoma with hereditary tainted history. Despite the fact that aggravated heredity has been confirmed as a risk factor for primary open-angle glaucoma (POAG), the information on the clinical features and progression patterns of POAG in patients with hereditary predisposition presented in the existing publications is scattered, and its availability is still limited by the amount of included material. All of this, in turn, makes it impossible to fully predict the course of the disease and to discuss the possibility of its earlier detection in that population group. The discussion presented in this work points out the type of kinship for which the risk of developing glaucoma is most relevant, as well as the supposed characteristics of the age of onset of POAG among patients with a family history of this disease. The results of the studies analyzed in this review can help actualize the viewpoint on the possible differences in clinical manifestations of the disease in patients with hereditary (familial) and sporadic forms of glaucoma, as well as on the necessity of further clinical research in this area.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114611160","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 : 2022-06-01DOI: 10.53432/2078-4104-2022-21-2-84-92
I. S. Makogon, D. I. Ivanova, A. L. Onishchenko
Glaucoma currently ranks first among the causes of irreversible blindness and low vision. Stabilization of the glaucomatous process, especially at its initial stages, can be achieved by using drug therapy to affect the proven risk factor — the level of intraocular pressure. Taking into account the elderly and senile age of patients with glaucoma and the presence of comorbid somatic pathologies, most common being cardiovascular system diseases, the issues of interaction between local and systemic therapy in this group of patients become especially relevant. This article reviews the role of β-blockers, which are often prescribed by both ophthalmologists and therapeutic specialists, the features of their use and interaction, the decrease in intraocular pressure provided by systemic therapy, their bioavailability, and the possible undesirable side effects as a result of mixed delivery. Raising the awareness among ophthalmologists, cardiologists and general practitioners on the potential problems of co-prescribing should encourage more careful approach to reviewing patients’ history of previously prescribed topical and systemic β-blockers.
{"title":"Beta-blockers: issues of drug interactions in local and systemic delivery","authors":"I. S. Makogon, D. I. Ivanova, A. L. Onishchenko","doi":"10.53432/2078-4104-2022-21-2-84-92","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-2-84-92","url":null,"abstract":"Glaucoma currently ranks first among the causes of irreversible blindness and low vision. Stabilization of the glaucomatous process, especially at its initial stages, can be achieved by using drug therapy to affect the proven risk factor — the level of intraocular pressure. Taking into account the elderly and senile age of patients with glaucoma and the presence of comorbid somatic pathologies, most common being cardiovascular system diseases, the issues of interaction between local and systemic therapy in this group of patients become especially relevant. This article reviews the role of β-blockers, which are often prescribed by both ophthalmologists and therapeutic specialists, the features of their use and interaction, the decrease in intraocular pressure provided by systemic therapy, their bioavailability, and the possible undesirable side effects as a result of mixed delivery. Raising the awareness among ophthalmologists, cardiologists and general practitioners on the potential problems of co-prescribing should encourage more careful approach to reviewing patients’ history of previously prescribed topical and systemic β-blockers.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"78 7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128100435","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 : 2022-06-01DOI: 10.53432/2078-4104-2022-21-2-67-76
E. A. Suleiman, S. Petrov
Glaucoma is a chronic disease characterized by optical neuropathy, progressive degeneration of retinal ganglion cells and nerve fiber layer, and is the leading cause of irreversible blindness in the world. Currently, the most reliable way to achieve stable normalization of intraocular pressure is surgical treatment, and its success is measured by the duration of the hypotensive effect. However, surgical interventions do not always have a prolonged effect. One of the most drastic and effective ways of treating patients with glaucoma is surgery involving installation of a drainage implant. The use of implants in the area of surgical intervention is the most effective way to preserve the outflow routes of intraocular fluid created during antiglaucoma interventions. The use of implants is aimed at reducing excessive scarring in the filtration zone and at creating ways of resorption of intraocular fluid. In the history of glaucoma surgery, numerous designs for drainage implants have been proposed, differing from each other in material, drainage structure, implantation technique, and results. This literature review describes the types of anti-glaucoma drainage devices and their latest modifications, and presents the statistics of postoperative complications and long-term results of the use of foreign- and Russian-made implants in the treatment of glaucoma.
{"title":"Drainage glaucoma surgery","authors":"E. A. Suleiman, S. Petrov","doi":"10.53432/2078-4104-2022-21-2-67-76","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-2-67-76","url":null,"abstract":"Glaucoma is a chronic disease characterized by optical neuropathy, progressive degeneration of retinal ganglion cells and nerve fiber layer, and is the leading cause of irreversible blindness in the world. Currently, the most reliable way to achieve stable normalization of intraocular pressure is surgical treatment, and its success is measured by the duration of the hypotensive effect. However, surgical interventions do not always have a prolonged effect. One of the most drastic and effective ways of treating patients with glaucoma is surgery involving installation of a drainage implant. The use of implants in the area of surgical intervention is the most effective way to preserve the outflow routes of intraocular fluid created during antiglaucoma interventions. The use of implants is aimed at reducing excessive scarring in the filtration zone and at creating ways of resorption of intraocular fluid. In the history of glaucoma surgery, numerous designs for drainage implants have been proposed, differing from each other in material, drainage structure, implantation technique, and results. This literature review describes the types of anti-glaucoma drainage devices and their latest modifications, and presents the statistics of postoperative complications and long-term results of the use of foreign- and Russian-made implants in the treatment of glaucoma.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122816789","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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