PURPOSE. To evaluate the effectiveness of surgical treatment of secondary glaucoma and to present the clinic features of the postoperative period of a patient with Sturge-Weber syndrome (SWS)
METHODS. A patient with SWS, choroidal hemangioma and secondary glaucoma was examined and treated (Ahmed valve implantation) in the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow.
RESULTS. On the first day after surgery on the left eye discovered: hypotension, decrease of the anterior chamber, serous choroidal detachment. Posterior scleral trepanation and injection of viscoelastic into the anterior chamber was performed. On the next day we got normalization IOP and complete choroidal attachment as a result of operation. But we got macular detachment of neuroepithelium, for this reason injections of glucocorticosteroids were performed with a positive effect. 1 month after surgery the retina and choroid are attached, IOP is 16 mm Hg on the left eye without hypotensive drops, visus for both eyes is 1.0.
CONCLUSION. Implantation of the Ahmed valve can be used in the treatment of secondary glaucoma in patients with SWS in order to reduce IOP and minimize the risks of complications.
ORIGINAL ARTICLES
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.
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.
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.
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.
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.
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.
REVIEW OF LITERATURE
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.
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.
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.
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.
ISSN 2311-6862 (Online)