Attack Of Angle-closure Glaucoma Research Articles

Adult-onset neuronal intranuclear inclusion disease related retinal degeneration: a Chinese case series.

To evaluate adult-onset neuronal intranuclear inclusion disease (NIID)-related retinopathy with guanine-guanine-cytosine repeat expansions in NOTCH2NLC. Neuro-ophthalmic evaluations, including best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP), ultrasound biomicroscopy, pupillometry, fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), Humphrey visual field, full-field electroretinography (ERG), and multifocal ERG (mf-ERG) were performed in patients with gene-proven NIID. Nine patients (18 eyes) were evaluated, with a median age of 62 years (55-68) and only one man was included in our study. Six patients presented with decreased visual acuity or night blindness, whereas the other three were asymptomatic. The visual acuity was measured from 20/200 to 20/20. Miosis was present in eight patients, four of whom had ciliary process hypertrophy and pronation, and three of whom had shallow anterior chambers. Fundus photography, FAF, and OCT showed consistent structural abnormalities mainly started from peripapillary areas and localized in the outer layer of photoreceptors and inner ganglion cell layer. ERG and mf-ERG also revealed retinal dysfunction in the corresponding regions. Patients with NIID showed both structural and functional retinopathies which were unique and different from common cone-rod dystrophy or retinitis pigmentosa. Patients with miosis may have a potential risk of an angle-closure glaucoma attack. Neuro-ophthalmic evaluations is essential for evaluating patients with NIID, even without visual symptom.

Acute glaucoma attack in a patient recovered from coronavirus infection (case report)

The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.

Клинический случай сочетания острого приступа закрытоугольной глаукомы с острым увеитом: конкуренция или синергизм

An atypical clinical case of a combination of an acute attack of angle-closure glaucoma with acute anterior uveitis with the simultaneous development of both diseases is represented. Keywords: acute attack of angle-closure glaucoma, acute anterior uveitis, differential diagnosis, therapy

Оценка коэффициента LAF в качестве критерия риска острого приступа закрытоугольной глаукомы

Purpose. To study the possibility of using the LAF coefficient in predicting an acute attack of angle-closure glaucoma (AACG) in anatomically short eyes of Europoids. Material and methods. In total, 4 groups of patients were formed: healthy individuals with hyperopia, patients with primary angle closure (PCA) of the anterior chamber, patients with primary angle-closure glaucoma (PACG), and patients with an acute attack of angle-closure glaucoma. The anteroposterior axis of the eye (APA), lens thickness (LT) were studied, and the LAF coefficient was calculated based on the results of these studies. Results. For each of the three factors studied (LT, APA, and LAF), an ROC analysis was performed to identify the cut-off points that best separate the hyperopic and acute attack groups. Cut-off points, sensitivity, specificity, areas under the ROC-curves (AUC) were found. Conclusion. Comparative analysis of LT and LAF parameters in the groups of hypermetropes, patients with PCA and with the initial stage of PACG did not reveal significant differences. In the acute attack group, LT and LAF were statistically significantly higher than the other groups. It was revealed that the LAF coefficient provides a better separation of the group of hypermetropes and the group of acute attack of the primary angle-closure, in comparison with the indicators of LT and especially the APA of the eyes. Our data showed that a high risk of an acute attack of glaucoma in eyes with a short APA occurs at LAF values greater than 2.332. This is confirmed by the high sensitivity, specificity and AUC of this indicator. Keywords: LAF coefficient, acute attack of angle-closure glaucoma, hypermetropia, primary closure of the anterior chamber angle

Difficulties of Cataract Surgery in Lens-Induced Glaucoma Due to Subluxated Cataract

Introduction: Cataract is a disease of the eye in which the normal clear lens has opacified and obscured the passage of light. A mature cataract occurs when the lens is opacified. Lens subluxation is a condition when the crystalline lens is not in its anatomical position that can result in decreased anterior chamber depth. It is a potentially high risk of developing pupillary block, leading to lens-induced glaucoma (secondary angle closure glaucoma). In this case, the definitive therapy is lens extraction, which is challenging for cataract surgeons. This case report aims to expose the difficulties of cataract surgery in lens-induced glaucoma due to subluxated cataract. Case Presentation: A 56-year-old male presented with unable to see in his right eye, followed by foggy vision, glare when seeing the light, and a history of an acute glaucoma attack. His right best corrected visual acuity (BCVA) was 1/300, and the intraocular pressure (IOP) was 5 mmHg on therapy with glaucoma medications. Slit lamp examination of the right eye showed a shallow anterior chamber, irradiated iris, mid-dilated pupil, completely cloudy lens, and a capsular instability around 12 to 6 clock hours (180°/2 quadrant). This patient was diagnosed with mature cataract and lens-induced glaucoma due to subluxated mature cataract and was given glaucoma medications also underwent phacoemulsification (PE) along with Intraocular lens (IOL) and capsular tension ring implantation due to the lens instability and excessive lens movement. Conclusions: Cataract surgery for subluxated mature cataract and lens-induced glaucoma is challenging because of the shallow anterior chamber, capsular instability, and excessive lens movement. A thorough diagnosis, preoperative evaluation, postoperative monitoring, and evaluation are essential for safe cataract surgery, reducing the risk of complications and achieving a good result.

Поиски возможностей объективного критерия риска развития острого приступа глаукомы в анатомически коротких глазах

Purpose. To assess the prognostic significance of the LAF coefficient (Lens thickness/ Axial length Factor) as risk factor for acute attack of glaucoma in anatomically short eyes of Europeans. Material and methods. 1st group consisted of 24 patients (48 eyes) with axial hyperopia. 2nd group included 24 patients (48 eyes) with primary closure of the anterior chamber angle. The 3rd group was formed by 17 patients (34 eyes) with initial stage of primary angle-closure glaucoma. The 4th group included 35 patients (35 eyes) with an acute attack of glaucoma. The studied groups did not differ in age (p = 0.97) and gender (p = 0.28). Lens thickness and axial length (AL) were measured using A-scan on biometer IOLMaster 700 (Carl Zeiss®, Germany) with calculation of LAF coefficient. Results. The LAF coefficient in the 4th (acute attack) group was statistically significantly higher than in the first 3 groups. The best separation of the 1st and 4th groups is provided by LAF coefficient compared to lens thickness and AL indexes with sensitivity, specificity and the Area Under the Curve (AUC) of 89 %, 83 % and 0.9, respectively. LAF coefficient values greater than 2.332 in patients with short AL are objectively associated with high risk of acute attack of glaucoma. The average value of the LAF coefficient (2.528) obtained by us in the 4th (acute attack of glaucoma) group significantly exceeds these indexes in works of other authors, which may be due to morphometric features of structure of eyes of Europeans compared to eyes of Asians. Conclusion. The LAF coefficient provides better separation of the 1st and 4th groups, in comparison with the lens thickness indexes, and especially the AL. LAF coefficient values greater than 2.332 in eyes with short AL objectively indicate high risk of acute attack of glaucoma, as evidenced by high sensitivity, specificity, and AUC. Keywords: acute attack of glaucoma, LAF, lens thickness, short axial length, risk factor

Анатомо-морфометрические факторы риска первичной закрытоугольной глаукомы в глазах с короткой ПЗО

Purpose. To study the features of t anatomical and morphometric parameters of structures of the anterior segment of the eyes in young patients with moderate and high hyperopia to identify signs of an increased risk of developing primary angle-closure glaucoma (PACG) and its acute attack. Material and methods. Clinical material is presented by 58 patients (116 eyes) with the anteroposterior axis of the eyes less than 23 mm. The main group consisted of 33 patients (66 eyes) with moderate and high hyperopia. The comparison group included 25 patients (50 eyes) with PACG. Results. The study made it possible to identify a group with an increased risk of developing PACG from a selected total population of young patients with moderate and high degrees of hypermetropia, which included 19 people (58 %). Conclusion. Comparative analysis of the morphometric parameters of the structures of the anterior segment of anatomically «short» eyes in young patients with moderate and high hypermetropic refraction, on the one hand, and in patients with PACG, on the other, revealed statistically significant differences between them in the depth of the anterior chamber in the central zone, thickness of the lens, the volume of the anterior chamber, the depth of the anterior chamber at the periphery, the angle of the anterior chamber. But, given the 1.5-fold statistically significant difference in age between the groups, it can be assumed that in some young hypermetropes, due to the continuous increase in the volume of the lens, when they reach the appropriate age, a number of indicators can become comparable to the PACG group. Keywords: hyperopia, refractive surgery, primary angle-closure glaucoma, acute attack of angle-closure glaucoma

Commentary: The impact of yoga practice on glaucoma.

Yoga is the most popular form of complementary therapy being practiced to maintain one’s physical and mental wellbeing. While yoga traditionally comprises advice for ethical lifestyle and spiritual practice, it is most often associated with physical postures (asanas), breathing techniques (pranayama), and meditation (dhyana). While these exercises are routinely safe, there are risks involved for certain patients including those suffering from or at risk of glaucoma. The effects of yoga on intraocular pressure (IOP) have been found to be bidirectional, and the exact mechanisms are not yet fully understood. The authors have reviewed literature to study the effect of yoga on IOP and glaucoma. They have observed a reduction of IOP in patients of glaucoma through Jyoti tratak (candle meditation) and slow yoga breathing exercises and a rapid increase in IOP immediately after head-down posture yoga.[1] Tratak kriya is said to lead to contraction and relaxation of ciliary muscles, which may possibly increase the aqueous humor outflow and subsequently decrease the IOP.[2] Dada et al.[3] have evaluated the effect of yoga and meditation on IOP, quality of life, stress markers, neurotrophins, and gene expression in patients with primary open-angle glaucoma and found an improvement in all parameters. On the other hand, progressive glaucomatous optic neuropathy and field loss in patients who regularly practiced Sirsasana (Headstand) has also been identified.[1,4,5] Four yogasanas [Adho Mukha Savasana (downward-facing dog), Uttanasana (standing forward bend), Halasana (plough pose), and Viparita Karani (legs-up-the-wall)] showed a 20–73.7% increase in IOP in all study subjects.[1] Yoga with head-down positions was associated with a rapid rise in IOP in glaucoma and healthy eyes and with the body vertical, with a doubling of the IOP, remaining elevated as long as the position was maintained.[1] Mani Baskaran et al.[6] observed a twofold increase in IOP during Sirsasana, which was maintained during the posture in all age groups irrespective of their ocular characteristics. Valsalva maneuver is known to affect IOP; so it is expected that breath-holding yogic exercises are likely to cause IOP elevation. Forced unilateral nostril breathing has also been observed to affect IOP significantly.[7] Rakstyte et al.[8] studied an impact on IOP before, during, and after Matsyasana (fish yoga pose) and found an increased IOP in head- down position which returns to the initial value shortly after. A case series by Mehrdad Malihi et al.[9] to study the effect of different body and head positions on IOP shows a lower measurement while sitting with a neutral neck position and a rise in IOP in all other positions. Acute angle-closure glaucoma attacks often precipitated by prone-position yoga exercises suggest that this position probably increases pupillary block in “at risk” eyes by causing the lens to fall onto the iris, which has been the principle of the prone provocative test for decades. Certain questions, however, remain unanswered. It is unclear whether yoga has any sustained effects on the IOP and optic nerve. Further research is needed to fully comprehend the mechanisms by which yoga exerts its effects and determine the types, optimal duration, and frequency of yoga practice for glaucoma patients. Future studies are also warranted to ascertain whether yoga-associated IOP changes are associated with parallel changes in perimetry and nerve fiber thickness and changes in cerebrospinal fluid pressure, blood pressure in lamina cribrosa capillaries, and the ocular blood flow. It is difficult to establish direct causality between different yogic postures and glaucomatous progression, but in patients with pre-existing glaucomatous optic neuropathy, dramatic changes in IOP can definitely be harmful. Inquiring about the practice of yoga in cases of unexplained progression despite an apparently well-controlled IOP can, therefore, be an important consideration. Relaxation and meditative aspects of yoga may help to reduce stress and improve the overall well-being of an individual which can be indirectly beneficial. The key is to “keep the head above the heart at all times.” It is also important to note that yoga should not replace traditional glaucoma treatment but rather be practiced/advised as a complementary therapy and glaucoma patients should consult their healthcare provider before beginning any new exercise or relaxation program, including yoga.

Features of cataract surgery and the postoperative period in patients with glaucoma (part 2)

According to the results of various studies, in up to 50% cases after cataract phacoemulsification patients with glaucoma experience ophthalmic hypertension on the first day. This occurs due to the mechanical retention of aqueous humor in the anterior chamber. Temporary decrease in the function of the eye drainage system is explained by pigment particles, viscoelastic, erythrocytes, protein cells, product of postoperative inflammation and lens particles obstructing the trabecula. In the long-term period after phacoemulsification in glaucoma patients there is a decrease in the intraocular pressure in up to 74% of cases.A decrease in the density of endothelial cells in these patients occurs as a result of fluctuation of intraocular pressure, prolonged application of hypotensive drops, surgical intervention and presence of drainage devices after antiglaucoma surgery. This leads to the increase of inflammatory reaction of the cornea in the form of edema of up to 16.9% after cataract phacoemulsification.Phacoemulsification also provides a significant hypotensive effect (up to 34%) and is a preventive measure for an acute attack in patients with angle-closure glaucoma. However, the state of acute glaucoma attack leads to difficulties in phacoemulsification in the form of high intraocular pressure, corneal edema and small chamber. Cataract extraction under such circumstances causes an increase in postoperative corneal edema and eye inflammation of up to 22.85%.

Diagnosis and treatment of angle-closure glaucoma

Glaucoma is a polyetiological disease, which is based on increased intraocular pressure, leading to impaired visual fields and pathology of the optic nerve. As a result of increased pressure, there is an increase in the hydrodynamic load on the optic disc, gradually leading to its atrophy. Progressive narrowing of visual fields is another classic sign of glaucoma. This disease is one of the main causes of vision loss and related disability of the population. There are three main forms of glaucoma: primary open-angle, primary closed-angle, and secondary glaucoma, which develops against the background of the existing pathology of the organs of vision (diabetic retinopathy, acute iridocyclitis, post-thrombotic oculopathy). Primary open-angle glaucoma is the most common form of the disease, usually affecting the elderly. Angle-closure glaucoma is less common, but it is more dangerous. This form of the disease is often observed against the background of existing hypermetropia. This type of primary glaucoma develops as a result of a violation of the outflow in the drainage system of the eye due to the occlusion of the internal scleral sinus. In this case, the anterior chamber is significantly reduced in size or even disappears, and the lens is close to the cornea. Angle-closure glaucoma is characterized by a paroxysmal course, rapid progression, and a less favorable prognosis. In some cases, an acute attack of angle-closure glaucoma requires immediate hospitalization with subsequent surgical intervention.

State of the art in acute glaucoma attack predisposition issue

Angle-closure glaucoma diagnosis verification is based on biometric indicators and computer tomography data of the anterior segment of the eye. However, not every patient with a narrow angle and a shellow anterior chamber develops an acute attack. The review summarizes the literature data on risk factors for an acute glaucoma attack and lists additional parameters to be considered when examining patients with angle-closure glaucoma to identify a predisposition to an acute glaucoma attack.

Выявление случаев повышенного риска первичной закрытоугольной глаукомы у молодых пациентов с высокой степенью гиперметропии

Purpose. Evaluation of the incidence of risk of primary angle-closure glaucoma (PACG) in young patients with a high hyperopia. Material and methods. The main group consisted of 58 healthy patients (116 eyes) with high hyperopia. Their age ranged from 32 to 40 years. Selection criteria: the anteroposterior axis (APA) of the eye is less than 22 mm, the absence of ophthalmic and systemic somatic pathology. The comparison group was formed by 52 patients (104 eyes) with high hyperopia (APA less than 22 mm) and the initial stage of PACG, as well as the presence of a functional block of the front camera angle. Their age ranged from 45 to 50 years with a median of 47 years. The morphometric parameters of the anterior segment of the eyes were evaluated in groups. Results. We determined statistically significant differences in all studied parameters of the compared groups: the depth of the anterior chamber in the central zone, the thickness of the lens, the volume of the anterior chamber. However, when comparing these indicators with the comparison group, it was found that in 15 patients in the main group, most of them were comparable. Conclusion. Comparative analysis of the topographic and anatomical parameters of the anterior segment of the eyes of young healthy hypermetropes made it possible to identify 15 people. (26 %) with an increased risk of developing PACG and an acute attack. Keywords: acute attack of angle-closure glaucoma, hyperopic refraction, anteroposterior axis of the eye, lens thickness, anterior chamber depth, anterior chamber volume.

Biometric risk factors for acute glaucoma attack

PURPOSE. To assess the prognostic significance of the LAF coefficient (Lens thickness/Axial length factor) as a risk factor for acute glaucoma attack in anatomically short eyes of Europeans.METHODS. Group 1 consisted of 24 patients (48 eyes) with axial hyperopia. Group 2 included 24 patients (48 eyes) with primary closure of the anterior chamber angle. Group 3 — 17 patients (34 eyes) with initial stage of primary angleclosure glaucoma. Group 4 — 35 patients (35 eyes) with an acute attack of glaucoma. The studied groups did not differ in age (p=0.97) and gender (p=0.28). Lens thickness and axial length (AL) were measured by A-scan with calculation of the LAF coefficient.RESULTS. The LAF coefficient in group 4 (acute attack) was statistically significantly higher than in the other three groups. The best separation of groups 1 and 4 was seen in LAF coefficient compared to lens thickness and AL with sensitivity, specificity and the area under the curve (AUC) of 89%, 83% and 0.9, respectively. LAF coefficient values greater than 2.332 in patients with short AL are objectively associated with high risk of acute attack of glaucoma. The average value of the LAF coefficient (2.528) observed in group 4 (acute attack of glaucoma) significantly exceeds these parameters in works of other authors, which may be associated with morphometric structural features of the eyes of Europeans compared to the eyes of Asians.CONCLUSION. The LAF coefficient provides better separation of group 1 and 4 in comparison with lens thickness and, especially, axial length. LAF coefficient values greater than 2.332 in eyes with short AL objectively indicate high risk of acute attack of glaucoma, as evidenced by high sensitivity, specificity, and AUC.

Phacoemulsification in prevention of acute angle-closure glaucoma attack

To study the changes in morphometric parameters of the anterior segment of anatomically short eyes with an increased risk of acute glaucoma attack before and after preventative PE. The study included 70 patients (70 eyes) with a high risk of acute glaucoma attack in short anatomical axial length and thickened lens, with posterior and middle positions of the ciliary body. They were divided into 2 groups: the main group consisted of 45 patients who agreed to undergo PE; the comparison group consisted of 25 patients who refused to undergo PE due to good visual functions and no complaints about vision. B-mode ultrasound examination of the anterior segment of the eye was used to evaluate the cross-sectional surface area of the lens (CSAL) and the cross-sectional surface area of the anterior chamber (CSAAC). In the main group, on day 2-3 after PE the anterior chamber depth increased in all eyes, the CSAAC index increased, the anterior chamber angle (ACA) widened to Schaffer grade to II-III. After 1-3 years and 4-5 years, the anterior chamber depth, the CSAAC index and the width of the ACA remained stable. In the comparison group, after 1-3 years the anterior chamber depth and the CSAAC index significantly decreased, the ACA narrowed, and the intraocular pressure increased; after 4-5 years, there was a progressive increase in the CSAL index, the ACA was completely closed (0°). In all cases of timely performed preventative PE, already on days 2-3 after surgery there was a statistically significant improvement in the main morphometric parameters of the eye, which remained stable for 4-5 years.

Vascular and vegetative factors of glaucoma attack

Purpose. To study the involvement of vascular and vegetative factors in the pathogenesis of glaucoma attack. Material and methods. 12 patients (24 eyes) aged 49 to 82 — 5 men and 7 women, including 3 patients with acute glaucoma and 9 patients with subacute glaucoma were subjected to an ophthalmological examination that included visometry, tonometry, automated static perimetry, OCT and OCT angiography. They were also tested for heart rate variability (HRV) using a Polar heart rate monitor, and for plasminogen content and products of fibrin/fibrinogen degradation in the tear. For comparison, the contralateral eyes of these patients were examined. Results. In the eyes with an acute glaucoma attack, the vascular network was noticeably weakened, especially in the area of the deep peripapillary vascular plexus at the lamina cribrosa level, and focal capillary loss was observed. The peripapillary density of the deep vascular plexus in the eyes with an acute attack was 33.0 ± 5.6 % (М ± m), which was significantly (p < 0.01) lower as compared to 50.0 ± 4.7 % in the unaffected eyes. This indicator correlated with the thickness of the ganglion cell complex (GCC) (p < 0.01). In unaffected eyes, no correlations were found between these glaucoma-related parameters. A significant amount of fibrin/fibrinogen degradation products was found in the tear of glaucoma patients, which may point to a violation of blood circulation in the optic nerve vessels. It has been established that glaucoma attack occurs with increased activity of sympathetic regulation of blood flow. Conclusion. When monitoring this contingent of patients, it is essential to determine the sympathetic-parasympathetic status of the patient. Taking into account the vascular component of the condition, it is expedient to introduce the necessary additions into its treatment plans

Pathogenetic Justification of a New View on the Treatment of Angle-Closure Glaucoma

Purpose. To study the effectiveness of vascular, anti-inflammatory and fibrinolytic therapy, to conduct a comparative assessment with treatment without vascular therapy in patients with angle-closure (ACG) and mixed glaucoma.Methods. A total of 55 patients with angle-closure and mixed glaucoma, mainly with hypermetropic refraction of varying degrees, were examined: 7 people with acute glaucoma attack, 6 people with subacute glaucoma attack (group 1, with anti-inflammatory treatment), 7 people with acute glaucoma attack and 6 people with subacute glaucoma attack (group 2, with vascular treatment), 14 people with chronic angle-closure glaucoma (group 3) and 15 people with mixed glaucoma (group 4). All patients underwent an ophthalmological examination, which included visometry, refractometry, tonometry, computer perimetry, OCT and OCT angiography, and an ELISA analysis to determine cytokines.Results. The administration of the drug Pentoxifylline as a cytokine blocker and antiplatelet agent in ACG contributed, in our opinion, to an improvement in visual acuity, perimetry (MD), an increase in the density of capillaries of the deep vascular plexus at the level of lamina cribrosa in the peripapillary zone (%), i.e. improved blood circulation in the vessels of the optic nerve disc and also contributed to the blockade of cytokines, mainly in the 2-nd group of patients. In our opinion, a personalized approach to the treatment of ACG is to maintain the improvement of blood circulation in the peripapillary zone by prescribing a course of treatment with Pentoxifylline for 6 months after surgery. After phacoemulsification, there was a significant increase in the density of capillaries of the deep peripapillary vascular plexus at the level of lamina cribrosa (p ≤ 0.05) (51.0 ± 3.5 %), and after further treatment with Pentoxifylline, the capillary density continued to increase in 2–4 groups in the next 6 months of follow-up. The thickness of RNFL (Retinal nerve fiber layer, structural parameter) decreased due to a decrease in edema in 1–2 groups, slightly increased in 3–4 groups, in our opinion, due to improved blood circulation. Increased reperfusion in the capillaries of the deep plexus during normalization of IOP in glaucoma patients and further treatment with pentoxifylline indicates the effectiveness of the proposed treatment in addition to surgical treatment. The results obtained emphasize the advantages of the proposed therapy for the treatment of patients with angle-closure and mixed glaucoma.Conclusion. To date, there are no clear recommendations of vascular therapy for the treatment of patients with ACG and mixed glaucoma, which creates the need for its addition to treatment regimens, taking into account the vascular component of ACG and mixed glaucoma.

Выяснение наличия повышенного риска формирования первичной закрытоугольной глаукомы среди пациентов с гиперметропической рефракцией в отделении рефракционной хирургии

Important physiological feature of the anatomically «short» eye is the disproportionately large volume of the lens relative to the volume of the eye. A gradual and continuous increase in the volume of the lens contributes to the anterior displacement of the irido-lenticular diaphragm, causing the functional block of the anterior chamber angle. This leads to persistent disorders of the hydrodynamics of the eye, up to the development of an acute attack of angle-closure glaucoma. Purpose. To study incidence of increased risk formation of primary angle-closure glaucoma (PACG) and its acute attack in young patients with moderate and high hyperopia (Hm). Material and methods. Clinical material was presented by 58 patients (116 eyes) with indicators of axial length of the eyes less than 23 mm. The main group consisted of 33 patients (66 eyes) with moderate and high Hm. The comparison group was represented by 25 patients (50 eyes) with PACG. Results. The study made it possible to identify group of increased risk of the formation of PACG, which included 19 people (58%), from selected general population of young patients with moderate and high Hm. Conclusion. Comparative analysis of morphometric parameters of structures of the anterior segment of the anatomically «short» eyes in young patients with moderate and high Hm, on the one hand, and in patients with PACG, on the other, revealed statistically significant differences between them in the anterior chamber depth in the central zone, the thickness of the lens, the anterior chamber volume, the peripheral anterior chamber depth, of the anterior chamber angle. Key words: primary angle-closure glaucoma, acute attack of angle-closure glaucoma, hyperopia, refractive surgery.

Клинический случай успешного лечения внутриглазной гипертензии, вызванной органическим блоком угла передней камеры после сквозной кератопластики

Clinical case of successful treatment ocular hypertension caused by organic closure of anterior chamber angle after penetrating keratoplasty is presented. The patient underwent keratoplasty in the right eye and on the first day after the operation the clinic of acute glaucoma attack in the operated eye was revealed. In view lack of effect from medication and laser treatment carried out, the synechiae surgical removal was done. Carbachol Intraocular Solution (0.1 ml MIO-CHOL Sterile Solution, APPASAMY OCULAR DEVICES (P) LTD. (PHARMA DIVISION), India) was injected into anterior chamber to narrow the pupil. But its action turned out to be paradoxical – instead of constriction there was sharp pupil dilation. In addition to standard treatment, the patient received keratoprotection and reparative therapy. To restore neurotrophic processes in the iris, intravenous infusions of 1000 mg of gliatilin were first performed, followed by a switch to the tablet form of this drug. After 4 months, the patient experienced increase in uncorrected visual acuity to 0.1; best corrected visual acuity – up to 0.2 with diaphragm against the background of complete absence of signs of inflammation. The graft was completely transparent, the intraocular pressure – 19 mm Hg, mydriasis persisted 5–6 mm, the reaction of the pupil to light appeared, but was weakened. Key words: ocular hypertension after penetrating keratoplasty, acute glaucoma attack, synechiae surgical removal.

Anterior eye segment damage in coronavirus infection (COVID-19)

Conjunctivitis may appear as the first symptom of the coronavirus infection (COVID-19). In isolated cases, the lesion of the conjunctiva evokes a systemic infectious process. Currently, the conjunctiva is not considered as an area of long-term reproduction of coronavirus, and its damage is caused by hyperproduction of pro-inflammatory cytokines (especially IL-6); development of iridocyclitis and keratoconjunctivitis is also possible. Most often, local corticosteroids are used to treat these processes, although their use requires caution due to the risk of activating secondary infection (herpetic bacterial, fungal), which often develops as a result of immunodeficiency caused both by COVID-19 and the massive corticosteroid and antibiotic therapy employed when the course of the disease is severe. The severe condition of patients, the lung ventilation, and the prone position all contribute to corneal erosions, exposure keratopathy, pseudomonas aeruginosa keratitis and angle-closure glaucoma attacks. The risk of transmission of coronavirus infection during keratoplasty is estimated as minimal.

Corneal Endothelial Cell Loss after Phacoemulsification in Eyes with a Prior Acute Angle-closure Attack.

PurposeTo evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs).MethodsThe medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared.ResultsThe study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p < 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p > 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05).ConclusionsPhacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.