Decrease In IOP Research Articles

COMPARISON OF INTRAOCULAR LENS IMPLANTATION WITH AND WITHOUT VISCOELASTIC SUBSTANCES IN PHACOEMULSIFICATION

Background: Life expectancy of the population may increase and cataract development may affect all the people with aging. Intraocular lens implantation surgery, a worldwide performed procedure, evolves and progresses. However, different techniques exist, which could be selected for different cases. Any ideal technique should be safe, simple, fast, and easy to learn with good clinical outcome. Objective: The aim of this work was to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification as well as surgery duration and post-operative intraocular pressure and central corneal thickness. Patients and methods: This was a prospective, randomized controlled trial conducted on 40 eyes with cataract; to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification of the lens as regard to surgery duration, post-operative intraocular pressure and central corneal thickness. Patients were evaluated 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups after the completion of lens cortex removal: Group A (n=20, hydro-implantation): One-piece acrylic intraocular lens implantation was performed with normal saline solution (0.9 solution) irrigation. Group B (n=20, visco-implantation): using Hydroxy-propyl-methyl-cellulose 2% implantation. Results: Highly significant increase in phaco operative time in visco-implantation group; compared to hydro-implantation group (p 0.05 respectively). Non-significant difference as regards post-operative Central corneal thickness (CCT) (p > 0.05). Non-significant increase in post-operative CCT measurements in visco-implantation group (p > 0.05). Non-significant difference in post-operative IOP measurements in visco-implantation group (p > 0.05). Non-significant decrease in post-operative IOP and CCT measurements in hydro-implantation group (p > 0.05). Non-significant decrease in post-operative IOP in hydro-implantation group; compared to visco-implantation group; during the serial 1st and 2nd measurements. Non-significant increase in post-operative CCT in Visco-implantation group; compared to hydro-implantation group; during the serial 1st and 2nd measurements. Conclusion: The hydro-implantation had similar clinical outcome to visco-implantation with advantage of reduced surgical time and cost, and no ophthalmic viscosurgical devices (OVD) induced intraocular pressure elevation postoperatively.

Beta-adrenergic glaucoma drugs reduce lymphatic clearance from the eye: A sequential photoacoustic imaging study

Our study aims to determine whether the beta-adrenergic system is involved in the regulation of lymphatic drainage from the eye. For this purpose, we assessed the effect of 2 topical beta-adrenergic blockers, timolol and betaxolol, commonly used as glaucoma drugs, on lymphatic clearance of albumin from the aqueous humor to neck lymph nodes. Adult mice were treated with either topical timolol, a non-selective β-blocker, 0.5% (n = 8), or topical betaxolol, a selective β1-adrenergic blocker, 0.5% (n = 6) twice daily for 14 days and compared to respective control groups (n = 5 and n = 7). Changes in lymphatic clearance from the eye were assessed using a quantitative in vivo photoacoustic imaging approach. In all subjects, right eye and neck lymph nodes were longitudinally assessed by sequential photoacoustic imaging just prior to near-infrared dye injection into the anterior chamber of the eye, and 20 min, 2 and 4 h after injection. Repeat measurements of mean pixel intensities (MPIs) of right eyes and nodes were performed at all timepoints. The areas under the curves (AUC) were calculated and the AUC of the treated-group was compared to that of controls using the Mann-Whitney U test. The slopes of MPI of each region of interest over time were compared using the linear mixed model after adjusting for IOP decrease after treatment and other parameters such as sex and body weight. In the timolol-treated group, right neck nodes showed significant decrease in AUC signal intensity compared with controls (P = 0.003), and significant decrease in slope of MPI compared with controls (P = 0.0025). In the betaxolol-treated group, right neck nodes showed significant decrease in AUC signal intensity compared with controls (P = 0.02), and significant decrease in slope of MPI compared with controls (P = 0.0069).Topical treatment with timolol and betaxolol reduced lymphatic clearance of albumin from the aqueous humor to the neck lymph nodes. This finding may be relevant for the management of secondary glaucomas and inflammatory eye disease in which the clearance of accumulated proteins and antigen from the eye is important to disease recovery and sight protection. This study suggests that the beta-adrenergic system plays a role in the regulation of lymphatic clearance from the eye.

Efficiency of brinzolamide and its combinations with timolol maleate in the treatment of primary open-angle glaucoma

PURPOSE. To evaluate the effectiveness of 1% brinzolamide solution (Brineks-M) and its combination with 0.5% timolol maleate solution (Brinarga) in the treatment of patients with primary open-angle glaucoma (POAG).METHODS. The study involved 56 patients (56 eyes) with initial or moderate POAG and normal or moderately increased intraocular pressure. Individually tolerated IOP, hydrodynamic parameters, hemodynamic parameters of the eye (by computer ophthalmoplethysmography), microcirculation (by OCT angiography of the optic nerve head) were determined during the study.RESULTS. The hypotensive effect of 1% brinzolamide solution (Brineks-M) in patients with the early stage of POAG (23 eyes) after 3 months was 22.5%. The antihypertensive effect of Brinarga in patients with early and moderate stages of POAG (33 eyes) was 31.3% and persisted for 3 months of observation.CONCLUSION. A decrease in IOP to an individually tolerable level was accompanied by an improvement in ocular hemodynamics and microhemocirculation of the optic nerve head, and stabilization of visual functions in patients with POAG.

Retrospective analysis of functional and anatomical changes, the level of intraocular pressure in patients with glaucoma and highgrade myopia during surgical treatment of cataracts

Purpose of the study. To conduct a retrospective analysis of functional, morphometric changes, the level of intraocular pressure after phacoemulsification of cataracts in the early and late postoperative period in patients with glaucoma and highgrade myopia.
 Materials and methods. A retrospective analysis of lens morphometric parameters, baseline IOP in patients with PVKG and MIA, IOP in the early and late postoperative period (12 months) in 60 patients who underwent surgical treatment of cataracts by phacoemulsification. There were 2 groups: 1 group consisted of 20 patients with glaucoma, including men – 11, women – 9, the average age of patients in this group was 73,42 ± 6,8 years, the second group consisted of 20 patients with MIA, including men – 8, women – 12, the average age was 71,46 ± 8,25 years. The control group included 20 patients with cataracts (36 eyes), of whom there were 10 men, 10 women, the average age of patients was 70,82 ± 10,25 years.
 Patients in all groups were homogeneous and comparable in sex and age. Patients of the 1st observation group were in a state of compensation for the level of IOP on the background of the use of antiglaucoma drugs. All patients underwent standard ophthalmological examination, including visometry, perimetry, tonometers, biomicroscopy, ophthalmoscope, echobiometry, keratorefractometry.
 Results. A retrospective analysis of functional and anatomical changes in patients with glaucoma and highgrade myopia during surgical treatment of cataracts indicates the effect of FEC + IOL on the condition of ophthalmotonus and functional parameters of the eyes in both early and late postoperative period.
 Conclusion. Analysis of examination of patients with primary openangle glaucoma and high grade myopia revealed differences in functional, morphometric parameters and the level of intraocular pressure after phacoemulsification of cataracts. Maximum corrected visual acuity (MCG) after phacoemulsification of cataracts was significantly increased in all observation groups. The frequency of thick lenses in the control group was 25%, in the group with PVKG – 35%, and in patients with MIA the incidence was minimal, «respectively – 10%. In the remote period 1 year after FEC there is a decrease in IOP in the control group and in glaucoma patients by 0,8 and 1,1 mm Hg, respectively, while in the group of patients in the Ministry of Internal Affairs there is an increase in ophthalmotonus by 0,7 mm Hg (P  0,05). The frequency of reduction of IOP 1 year after FEC is 70% in patients of the control group, 55% in patients with glaucoma and 10% in patients with high myopia.

Микроимпульсная хирургия глаукомы в комбинированном лечении неоваскулярной глаукомы

Purpose. To evaluate the effectiveness of micropulse laser glaucoma surgery in the combined treatment of patients with secondary neovascular glaucoma. Material and methods. The study included 24 patients (24 eyes) with secondary neovascular glaucoma. All patients underwent micropulse transcleral laser treatment. Results. A week after treatment, the IOP level was 23.1±10.2 mm Hg on the hypotensive drops. A decrease in IOP was achieved by an average of 34% from the preoperative one, and then a gradual decrease in the hypotensive effect was observed with a decrease in IOP by an average of 21-22% from the initial one 1 year after the operation. In 5 cases, in patients with terminal glaucoma, normalization of IOP was not achieved, but in all cases, relief of pain was noted. Conclusion. Micropulse laser glaucoma surgery can be used in the complex treatment of neovascular glaucoma in order to reduce IOP. Key words: secondary neovascular glaucoma, micropulse laser glaucoma surgery, proliferative diabetic retinopathy, CVS thrombosis, anti VEGF.

Клинические результаты лечения открытоугольной глаукомы микроимпульсной транссклеральной циклофотокоагуляцией

Purpose. To evaluate treatment efficiency of open-angle glaucoma with micropulse transscleral cyclophotocoagulation, to determine the optimal total energy of laser exposure and to assess the stability of the glaucoma process after treatment. Material and methods. A prospective study was carried out. It included 34 (21 patients) with primary open-angle and pseudoexfoliative glaucoma of stages 1-3, which undergone micropulse transscleral cyclophotocoagulation. The patients were divided into subgroups 1 and 2, depending on the total amount of laser energy (100 J and 150 J, respectively). At different periods of observation, the intraocular pressure, best corrected visual acuity, visual fields, cup-to-disc ratio and the number of antiglaucoma drugs were determined. Results. In the general group, all operated patients achieved a decrease in IOP to a tolerant level, from a median value of 27 [25; 28] in the preoperative period, up to 17.5 [15; 20] at the end of the observation period. The number of used drugs decreased statistically significantly, from 3.0 [3.0; 3.0] to 2.0 [1.0; 2.0]. There was a statistically significant increase in the mean deviation of the retinal photosensitivity, from –4.85 [–8.25; –2.17] to –4.36 [–7.06; –2.37] after 18 months. Indicators of best corrected visual acuity and CDR remained stable throughout the observation period. In subgroup 2 (150J), a statistically more significant decrease in IOP level (p=0.033) and the number of used drugs (p=0.001) was achieved compared with subgroup 1 (100J). Conclusion. Micropulse transscleral cyclophotocoagulation is an effective and safe method of treating open-angle glaucoma in patients with early stages of the disease and high values of best corrected visual acuity. Using a total amount of energy in 150J contributes to a more pronounced decrease in IOP and a decrease in the number of applied drugs than an energy in 100J. Key words: open-angle glaucoma, pseudoexfoliative glaucoma, micropulse cyclophotocoagulation.

Применение микроимпульсной транссклеральной циклофотокоагуляции в лечении глаукомы. Предварительные результаты

Objective. To evaluate the preliminary results after micropulse cyclophotocoagulation in patients with primary open-angle refractory glaucoma (POAG) and neovascular glaucoma. Methods. Retrospective study of adult patients with glaucoma, with at least 6 months follow-up after the only one session of micropulse laser therapy. The study included 16 patients, 17 eyes with refractory primary open-angle glaucoma (POAG) and neovascular glaucoma. Follow up period was 6 months. The same surgical technique was used in all cases. The wavelength of the laser beam was 810 nm, the total exposure was 160 s, the energy was 2000 mJ, 31,3% of active cycle, the pulse duration was 0.5 ms, the period was 1.1 ms. Results. The average decrease in IOP was 26.6%. No complications identified Conclusions: micropulse transscleral cyclophotocoagulation has been shown to be safe and effective in lowering IOP in patients with refractory glaucoma. However, further study of this method is required. Key words: micrоpulse transscleral cyclophotocoagulation, glaucoma, intraocular pressure.

Оптическая когерентная томография и оптическая когерентная томография-ангиография в определении прогрессирования глаукомы

Purpose. To study the role of optical coherence tomography (OCT) and OCT angiography (OCTA) in the detection of the primary glaucoma progression. Material and methods. The prospective study of 128 patients with primary glaucoma (128 eyes), conducted from 2015 to 2019, included at least 6 standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT) examinations in each patient; OCTA was also used during the last year of observation. To determine the disease progression, the trend and event analysis using the Humphrey Field Analyzer was performed. The fact and rate of thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated. If they had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The values of corneal-compensated IOP were also considered: minimal (IOPmin) and peak (IOPmax). Results. Glaucoma progression was detected in 79 eyes. The isolated use of SAP allows detecting the progression only in 2.3% cases, SD-OCT - in 37.5%, among them the isolated assessment of GCC amounted to 7.8%, and RNFL – to 5.5%. The complex dynamic morphological and functional assessment increased the possibility of progression detection up to 61.7%. Progression was related to the stage of glaucoma damage at the moment of diagnosis: for the perimetry index PSD p=0.025, for the focal loss volume of GCC p=0.024, as well as with the level of minimal IOP (p=0.04). All patients with progression have shown the vessel density decrease in the peripapillary retina and parafovea. Conclusion. SD-OCT plays an important role in detecting the progression of glaucoma. The complex dynamic morphological and functional assessment allows detecting the progression in over half of patients. Progression is associated with the initial stage of glaucoma and an insufficient IOP decrease during treatment, accompanied by retinal microcirculation deterioration. Key words: primary, glaucoma progression, optical coherence tomography, OCT-angiography, IOP.

A Variant of Micro-Invasive Glaucoma Surgery: Calibrated Reverse Meridional Cyclodialysis ab interno Involving Implantation of a Non-Absorbable Collagen Implant

Purpose. To assess safety and effectiveness of calibrated cyclodialysis ab interno involving implantation of a non-absorbable collagen implant in the suprauveal space in decreasing IOP in glaucoma patients.Methods. Forty-three patients (43 eyes; 16 male and 27 females; average age — 70.4 ± 10.0 years) were included in this pilot study. A 6 mm long and 2.0 mm wide cyclodialysis cleft was created ab interno in one of the lower quadrants of the eye using a specially designed spatula followed by insertion of a strip of implant in the cleft. In 19 eyes (44.3 %) the procedure was performed as standalone procedure and in 24 eyes (55.7 %) along with cataract surgery. Outcome measures were IOP change, use of hypotensive medication(s), complications, and need for a second surgery. Decrease in IOP by >20 % and IOP between 6 and 21 mmHg without hypotensive medication(s) constituted complete success; similar changes in IOP with medication(s) constituted partial success. Need for second surgery constituted failure.Results. At 6 months, baseline IOP decreased from 20.6 ± 7.4 mmHg to 12.9 ± 4.9 mmHg (a decrease by 37.4 %; р < 0.001) and hypotensive medication use reduced from 2.6 ± 0.8 to 1.0 ± 1.1 (a reduction by 57.7 %; р < 0.001). Complete success was achieved in 19 eyes (44.2 %), partial in — 15 eyes (34.9 %). Nine eyes had unsuccessful outcomes (20.9 %); among these, seven eyes (78 %) had severe glaucoma and five eyes (55 %) had undergone previously glaucoma surgeries. Hemorrhaging at the cleft site was the most common intraoperative complication — 18 eyes (41.9 %). Postoperative complications included hyphema, which was completely resorbed within one week.Conclusion. Calibrated cyclodialysis ab interno procedure involving implantation of a non-absorbable collagen implant in the suprauveal is safe and easy to perform. It effectively decreases IOP in patients with moderate glaucoma but is less effective in patients with severe glaucoma and in patients with previously failed glaucoma surgeries. Complications were found to be minimal.

EXPERIENCE OF LUCENTIS APPLICATION IN TREATMENT OF NEOVASCULAR GLAUCOMA AGAINST THE BACKGROUND OF PROLIFERATIVE DIABETIC RETINOPATHY

The study involved 23 patients (23 eyes) with neovascular glaucoma against the background of proliferative diabetic retinopathy. The first stage was the intravitreal injection of Lucentis, then with IOP > 25 mm Hg - transscleral cyclophotocoagulation and after 2 weeks panretinal laser coagulation in ischemic zones; with IOP < 25 mm Hg - panretinal laser coagulation in ischemic zones. At all observation periods there was a statistically significant decrease in IOP and in rubeosis. One week after the last stage of treatment the overall decrease in IOP was 33.4 % of the initial values, rubeosis was not detected. The application of Lucentis in combination with transscleral cyclophotocoagulation in the treatment of neovascular glaucoma against the background of proliferative diabetic retinopathy allows to achieve stable IOP normalization, preserving residual visual functions and reducing the risk of hemorrhagic complications.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РЕЗУЛЬТАТОВ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ОТКРЫТОУГОЛЬНОЙ ГЛАУКОМЫ МЕТОДАМИ МИКРОИМПУЛЬСНОЙ ТРАНССКЛЕРАЛЬНОЙ ЦИКЛОФОТОКОАГУЛЯЦИИ И СИНУСТРАБЕКЛЭКТОМИЕЙ

Purpose of the study: Evaluate the efficiency and compare results of micropulse transscleral cyclophotocoagulation(mCPC) and trabeculectomy in treatment of patients with open-angle glaucoma of stages 1—3. Materials and methods: In our study 67 surgical interventions were performed to reduce the level of IOP. The patients were divided into two groups depending on the used surgical technique: group I (study) — 34 eyes (21 patients) which underwent micropulse transscleral cyclophotocoagula- tion, group II (comparison) — 33 eyes (33 patients), trabeculectomy was performed. The groups were comparable in terms of the main indicators affecting the final treatment outcome. During the period of observation the level of intraocular pressure, the best corrected visual acuity, visual fields, cup-to-disc ratio and the amount of antiglaucoma drugs used were determinated. Results: In both groups, a statistically significant decrease in IOP was achieved at the end of the observation period (p < 0.001), the groups were comparable in terms of this indicator (p = 0.61). There was a statistically significant decrease in the number of drugs taken (p < 0.001) in both groups. Comparison of groups I and II showed a statistically significant difference in terms of the indicator at the observation periods of 3, 6 and 12 months, and the absence thereof after 18 months (p = 0.072). BCVA in group I was stable (p = 0.53 after 18m.), In group II, statistically insignificant positive dynamics in BCVA were observed (p = 0.046 at pcrit. = 0.125 after 18m). Both groups were comparable throughout the observation period in terms of CDR and the MD of the retina light sensitivity. Group I patients did not require additional surgical treatment, 9 patients of group II underwent 12 additional interventions aimed at treating complications. Conclusion: Micropulse transscleral cyclophotocoagulation allows to achieve a pronounced decrease in the IOP level and a decrease in the number of the applied drugs. MCPC is comparable in efficiency with trabeculectomy, in the absence of complications that require additional surgical treatment and affect the success of treatment, which is typical for trabeculectomy. The use of mCPC provides a stable course glaucomatous neuroopticopathy comparable to trabeculectomy.

Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma

Purpose:To evaluate long-term perimetric stabilization at set Target (IOPs) in primary angle-closure glaucoma with visual field defects.Methods:Two hundred forty-eight eyes, of 124 primary angle-closure glaucoma (PACG) patients on medical treatment, and 124 eyes, of 95 patients after trabeculectomy performed at least 5 years prior were evaluated. One hundred eighty-five eyes had a follow-up of ≥10 years. Target IOPs for mild, moderate, and severe glaucomatous optic neuropathy were set at ≤18, ≤15, and ≤12 mmHg, respectively. Progression was evaluated by event-based changes on guided progression analysis. Primary outcome measure was therapy required to achieve individualized Target IOP. Secondary outcome measure was assessment of perimetric change over time.Results:Mean baseline IOP was 23.34 ± 6.16 mmHg in medically treated and 36.08 ± 9.73 mmHg in surgically treated eyes (P = 0.0001). All eyes with a baseline IOP of <25 mmHg were on medications alone, 65.33%, of those with a baseline IOP of 25–30 mmHg were on medications, while 34.67% required trabeculectomy. In total, 91.4% of eyes with a baseline IOP of >30 mmHg underwent a trabeculectomy for achieving Target IOP. Perimetric stabilization was achieved in 98.17% of PACG eyes. “Target” IOP was achieved for mild, moderate, and severe glaucomatous optic neuropathy, medically in 90.2, 73.9, and 29.7%, and surgery was required in 9.8, 26.1, and 70.3%, respectively. Overall analysis found that percentage reduction in IOP was significantly more after trabeculectomy than medical treatment, 64.16 ± 14.91 and 43.61 ± 13.73%, P = 0.0001. Decrease in IOP was significantly greater 5–9 years after trabeculectomy, in comparison to ≥10 years, P = 0.001.Conclusion:Medications controlled IOP to “Target” in PACG eyes with mild and moderate glaucoma for over ≥10 years, when the baseline IOP off treatment was <30 mmHg. Trabeculectomy was necessary in PACG eyes having severe glaucomatous optic neuropathy, or with a baseline IOP of >30 mmHg to achieve Target IOP. These appropriate initial therapeutic interventions and Target IOPs are therefore suggested as a clinically validated algorithm of care for different severities of PACG.

Исследование биомеханических свойств роговицы на приборе CORVIS ST (Oculus, Германия) у пациентов с миопией и миопическим астигматизмом

Purpose. To evaluate the corneal biomechanical properties using the CORVIS ST device (Oculus, Germany) in patients with myopia and myopic astigmatism with intact cornea as well as in patients with myopia and myopic astigmatism who underwent excimer laser refractive surgery using femtolaser or microkeratome. Material and methods. Totally the study included 65 patients aged 18 years to 56 years with myopia and myopic astigmatism of various degrees were examined. They were scheduled for excimer laser refractive surgery after laser refractive surgery in different periods from 5 days to 5 years. Among the additional methods of examination, all patients were measured the biomechanical properties of the cornea using a CORVIS ST device (Oculus, Germany). Results. After excimer laser refractive surgery performing for myopia and myopic astigmatism correction, indicators of the corneal biomechanical properties, namely indicators describing stiffness and elasticity were changed, as well as IOP indicators. Conclusion. The biomechanical properties of the cornea, such as stiffness and elasticity, can be assessed using the CORVIS ST device (Oculus, Germany). After excimer laser vision correction of myopia and myopic astigmatism, corneal stiffness and elasticity decreases. IOP value in patients after excimer laser correction of myopia and myopic astigmatism decreases. It is associated with a decrease in corneal thickness but is not associated with a true decrease in IOP. Key words: biomechanical properties of the cornea, refractive surgery, excimer laser vision correction, femtolaser vision correction, myopia, myopic astigmatism.

Effect of Cataract Surgery on Intraocular Pressure in Glaucoma Patients

Purpose: To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019.&#x0D; Methods: Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age &gt; 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated.&#x0D; Results: A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg.&#x0D; Conclusion: Phacoemulsification produces a useful decrease in IOP in glaucoma patients.&#x0D; Key Word: Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.

Intraocular Pressure Decrease Does Not Affect Blood Flow Rate of Ophthalmic Artery in Ocular Hypertension.

PurposeTo investigate if decrease of IOP affects the volumetric blood flow rate in the ophthalmic artery (OA) in patients with previously untreated ocular hypertension.MethodsSubjects with untreated ocular hypertension (n = 30; mean age 67 ± 8 years; 14 females) underwent ophthalmologic examination and a 3-Tesla magnetic resonance imaging investigation. The magnetic resonance imaging included three-dimensional high-resolution phase-contrast magnetic resonance imaging to measure the OA blood flow rate. The subjects received latanoprost once daily in the eye with higher pressure, the untreated eye served as control. The same measurements were repeated approximately 1 week later.ResultsThe mean OA blood flow rate before and after treatment was 12.4 ± 4.4 and 12.4 ± 4.6 mL/min in the treated eye (mean ± SD; P = 0.92) and 13.5 ± 5.2 and 13.4 ± 4.1 mL/min in the control eye (P = 0.92). There was no significant difference between the treated and control eye regarding blood flow rate before (P = 0.13) or after treatment (P = 0.18), or change in blood flow rate after treatment (0.1 ± 3.1 vs. −0.1 ± 4.0 mL/min, P = 0.84). Latanoprost decreased the IOP by 7.2 ± 3.1 mm Hg in the treated eye (P < 0.01).ConclusionsThe results indicate that a significant lowering of IOP does not affect the blood flow rate of the OA in ocular hypertension subjects. The ability to maintain blood supply to the eye independent of the IOP could be a protective mechanism in preserving vision in subjects with ocular hypertension.

Changes of Anterior Chamber Biometry and Relationship to Intraocular Pressure Changes after Phacoemulsification Emulsification Surgery in Non-Glaucomatous Eyes

Fifty percent of blindness worldwide is attributed to cataract, and cataract surgery is the most commonsurgery performed by ophthalmologist. Cataract surgery has its effects on the structures of the anteriorsegment, and hence the aqueous humor outflow, these may include more space in anterior chamber, widerangles, as the thick aging lens would be replaced by the thinner intraocular lens. So this study to investigatethe changes in anterior segment parameters and its correlation to IOP changes after phacoemulsification.A prospective Cohert study that was done at Ibn Al-Haitham Teaching Eye Hospital for patients plannedto have phacoemulsification, for 55 patients during 8 months, from the 1st of July/2018 until the 28th ofFebruary/2019. The data included full preoperative and postoperative assessment, key parameters were:axial length measurement, intraocular lens, anterior chamber depth, anterior chamber volume, anteriorchamber angle for the four quadrants and their mean value was calculated. It was done before the operationsand after two months from the operation. Findings were the mean age of the study group was 56.9years,with 30 (54.5%) males and 29 (52.7%) right eyes,. The mean axial length was 23.12±1.11 mm. There werestatistically significant differences in preoperative compared to postoperative values of IOP (decreased by4.55 mmHg), anterior chamber depth (increased by 0.74 mm), volume (increased by 32.75 µl), and meanangle (increased by11.78 degree) maximum inferiorly (12.31 degree) and minimum superiorly. There wereno statistically significant correlation between IOP changes with anterior chamber depth, volume, or angles,but there was a statistically significant correlation with preoperative IOP .Conclusions cataract surgerysignificantly decreases the IOP, and increase anterior chamber depth, volume, and angle. The decrease in IOPdoes not correlate with anterior chamber depth, volume, and angle. The decrease in IOP was significantlyhigher in patients with higher preoperative values of IOP.

Эффективность и безопасность надпороговой селективной лазерной трабекулопластики как первого этапа лечения начальной стадии первичной открытоугольной глаукомы у пациентов с катарактой на фоне псевдоэксфолиативного синдрома

Suprathreshold selective laser trabeculoplasty (SLT) is a modification of the classical subthreshold SLT. Purpose . To study the clinical efficacy and safety of suprathreshold SLT as the first stage of combined surgical treatment of the early primary open-angle glaucoma in patients with cataract against the background of pseudoexfoliation syndrome. Material and methods . The study of 48 suprathreshold SLT cases (48 eyes) was performed in patients with early primary open-angle glaucoma (POAG) with cataract against the background of pseudoexfoliation syndrome. Results . The drug therapy led to IOP decrease from 22.1±3.2 to 16.3±2.6 mm Hg (-26.3%). An additional IOP decrease to 14.3±1.8 mm Hg was determined 1 month after suprathreshold SLT (-34.8%). A significant improvement in the coefficient of intraocular fluid easiness outflow was noted from 0.12±0.03 to 0.16±0.03 mm3 /mm Hg·min. The decrease in IOP was accompanied by a significant improvement in MD and PSD indicators according to static perimetry and a decrease in the area of the optic disc excavation. Colorimetric analysis showed a decrease in pigmentation of the trabecular meshwork. The density of corneal endothelial cells has not changed: PEC – 2204±392 cells/mm2 . There wasn’t any clinical case of reactive hypertension, pain by palpation in the ciliary body projection, precipitates or Tyndall phenomenon during the study. Conclusion . According to the study, suprathreshold SLT is an effective and safe method of the early primary open-angle glaucoma treatment in patients with cataract against the background of pseudoexfoliation syndrome.

Micropulse transscleral cyclophotocoagulation for the treatment of glaucoma

Because of the unpredictable hypotensive effect and serious complications during continuous-wave cyclophotocoagulation (CW-CPC), the use of this method in the treatment of glaucoma is limited. Therefore, a new technique was developed, known as micropulse trans-scleral cyclophotocoagulation (MP-CPC). During MP-CPC, a series of short bursts of laser pulses deliver energy to the ciliary body at the near-infrared wavelength of 810 nm, which is strongly absorbed by melanin. As shown by experimental studies, there are several acting mechanisms which reduce IOP decrease during MP-CPC. In clinical studies, patients with different forms and stages of glaucoma received laser energy of similar parameters during MP-CPC. It may be concluded that MP-CPC is a safe and effective alternative to traditional CW-CPC. However if laser irradiation directed to the ciliary body during MP-CPC gets longer, the incidence of complications increases. The variation of glaucoma forms in patients who underwent MP-CPC and a relatively small number of cases involved in the studies prevent us from making an unambiguous recommendation of this technique at the moment. An extensive research of the technique is required.

Comparison of surgical outcomes between sulcus and anterior chamber implanted glaucoma drainage devices

PurposeThis retrospective case-control cross-sectional study compared the outcomes of sulcus placement of glaucoma drainage devices (GDD) versus traditional anterior chamber (AC) to test the hypothesis that sulcus placement results in fewer complications whilst maintaining similar efficacy. MethodsThis study included 45 patients in the sulcus group and 60 patients in the anterior chamber (AC) group who had undergone surgery from January 2014 to December 2017. Data were collected on pre-operative demographics, operative details and post-operative intraocular pressure and complications. The IOP, number of medications and complications between the two groups was compared. A p value of < 5% was considered statistically significant. ResultsThe sulcus group had significantly lower overall complications compared to the AC group with a comparable IOP decrease between groups. There were significantly lower rates of hyphaema in the sulcus (3 cases) compared to AC group (17 cases) (P < 0.05). Severe or late complications (implant exposure, corneal decompensation, endophthalmitis, poor vision, choroidal hemorrhage and cornea edema) were significantly lower in the sulcus group [2 eyes; 4.4%] compared to the AC group [13 eyes; 21.7%] (P < 0.05). The sulcus group required fewer medications during the follow-up period. Conclusion(s)Sulcus implantation of GDD resulted in less postoperative hyphaema and severe complications compared to AC implantation. Our findings concur with the literature that sulcus implantation is safe and effective for controlling IOP for various types of glaucoma. The long-term effects of endothelial cell loss for sulcus versus AC implantation require further evaluation.

Анализ состояния внутриглазного давления после факоэмульсификации с имплантацией ИОЛ при сочетании катаракты с первичной открытоугольной глаукомой

Purpose. To evaluate the effectiveness of surgical resection of the sclera in patients with primary open-angle and secondary glaucoma. Materials and methods. The study included 84 patients with POAG and SG stages III-IV and decompensated IOP level (not higher than 32 mm Hg). In order to normalize the increased ophthalmotonus, a non - penetrating operation was performed-surgical resection of the sclera (SRS). The patients underwent complex ophthalmological examination and dynamic observation. Result. In the studied groups of patients after surgical treatment there was a decrease in elevated IOP levels by 33.42%, an improvement in the coefficient of ease of outflow and a weakening of the hypotensive regime. Stabilization of visual functions was observed in all patients. Summary. The proposed new SRS technique provides a smooth decrease in IOP, preservation of visual functions and is not accompanied by intra-and postoperative complications. Key words: primary open-angle glaucoma, surgical resection of sclera, secondary glaucoma, uveoscleral outflow pathway (USPO), intraocular pressure, EO coefficient .