Stages Of Glaucoma Research Articles

Glaucomatous optic nerve damage in the contralateral eye of a patient with peripapillary retinoschisis: a case report

BackgroundPeripapillary retinoschisis (PPRS) is often associated with glaucomatous eyes. It usually occurs in eyes with a more advanced stage of glaucoma with obvious optic nerve damage. We report a patient who was found to have PPRS in one eye during a routine physical examination without obvious glaucoma symptoms. Further examination revealed glaucomatous visual field loss and retinal nerve fiber layer defects in the contralateral eye.Case presentationA 55-year-old man presented for a routine physical examination. The anterior segment was normal in both eyes. Fundus examination revealed an elevated and red optic disc in the right eye. In addition, scattered patchy red lesions were seen on the retina on the temporal side of the optic disc. The color and boundary of the left optic disc were normal, and the cup-to-disc ratio was 0.6. Optical coherence tomography showed retinoschisis on the optic nerve head of the right eye throughout the entire circumference, extending to the retina on the temporal side of the optic disc. The intraocular pressure was 18 mmHg OD and 19 mmHg OS. The patient was diagnosed with PPRS (OD). However, no optic disc pit or optic disc coloboma was found. Further examination showed that the visual field of the patient’s right eye was generally normal, while a glaucomatous visual field defect was found in the left eye, which manifested as a nasal step visual field defect. Moreover, stereophotography and a red-free fundus image revealed two retinal nerve fiber layer defects in the supratemporal and infratemporal regions of the retina of the left eye. Continuous intraocular pressure measurement found that the intraocular pressure fluctuated between 18 and 22 mmHg OD and 19–26 mmHg OS during the daytime. Primary open-angle glaucoma was then diagnosed.ConclusionsIn this case, we found that PPRS was associated with glaucomatous optic nerve changes and visual field defects in the fellow eye.

Amsler Grid Versus 10-2 Test in Primary Open Angle Glaucoma.

Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic neuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG). This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp-Parrish-Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)]. A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively. The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.

Наблюдательное несравнительное одноцентровое исследование эффективности и безопасности фиксированной комбинации Тобрамицин 0,3% + Фторметолон 0,1% (глазные капли) в качестве предоперационной подготовки и послеоперационного ведения пациентов с ВМД влажной формы после интравитреального введения ранибизумаба

Purpose. To evaluate safety and efficacy of Floas-T ® (Tobramycin 0.3% + Fluormetholone 0.1%) as a preoperative preparation and postoperative management of patients with wet form of age-related macular degeneration (AMD) before and after intravitreal injection (IVI) of anti-VEGF drugs. Material and methods. 50 patients (50 eyes) with the wet form of AMD were examined and divided into two groups. The first group included 32 patients (32 eyes) with wet form of AMD. The second group consisted of 18 patients (18 eyes) with primary (11 eyes) and advanced (7 eyes) stages of primary open angle glaucoma with normalized IOP and wet form of AMD. Results. There were no significant changes in ВСVA and tonometric IOP values in the two groups before and within 7 days after IVI of ranibizumab and Floas-T ® instillations. Average value of individually tolerable true IOP in patients of the second group was 16,3±1,1 mm Hg, while average value of initial true IOP (14,7±2,56 mm Hg) pre-op was lower than tolerable pressure, indicating that individual norm of ophthalmotonus in glaucoma patients was reached. The difference between the mean values of ocular hydrodynamics in both groups before and 1 week after surgery was also statistically unsignificant (p&gt;0.05). The difference between the mean values of the Schirmer I test was statistically unsignificant in patients in the two groups (p&gt;0.05) before and after surgery, indicating the absence of Floas-T ® effect on tear production. There were no local and systemic side effects of Floas-T ® in 50 patients (50 eyes) during the observation period. Conclusion. Floas-T ® had an antiinflammatory effect without a decrease in the aqueous humor outflow, did not cause a significant increase in IOP in the early postoperative period, did not decrease tear production, and did not cause adverse local and systemic side effects. Floas-T ® can be used as a preoperative preparation and postoperative management drug in patients with wet type of AMD as well as in combination with primary open angle glaucoma when achieving an individual level of intraocular pressure. Key words: wet AMD, preoperative preparation, postoperative management, Floas-T® drug

Clinicopathological features of corneal invasion by filtering bleb

PurposeTo describe the clinicopathological characteristics and explore the possible etiology of cornea invasion by filtering bleb (CIFB) after filtering surgery.MethodsWe reviewed 22 patients treated for CIFB between March 2005 and March 2022. The patients were followed up for more than 1 year. Slit-lamp examination, optical coherence tomography (OCT), ultrasound biomicroscopy, and histopathological examination were performed to observe the morphology of the bleb and depth of corneal invasion. Depending on the severity of the lesion, treatments consisting of local massage, acupuncture separation, or surgical resection were administered.ResultsThe mean age of the patients was 56.3 ± 8.8 years. All patients underwent filtering surgery in the moderate or advanced stage of glaucoma. The filtering bleb was closely connected with the cornea, and its posterior boundary was locally adhered. Forward displacement of the internal opening of the filtering bleb was found in 4 of 7 surgically treated patients. OCT and pathological examination showed that the filtering blebs invaded the corneal stroma. Removal of the adhesion of the posterior boundary of the filtering bleb by different treatment methods successfully improved the patients’ conditions.ConclusionFiltering blebs can invade the corneal stroma. Adhesion of the posterior boundary and forward displacement of the internal opening of the filtering bleb are the possible causes of CIFB. Removal of the adhesion of the posterior boundary of the filtering bleb can halt the progression of CIFB.

Changes in target IOP values in glaucoma patients depending on the number of surgical interventions they underwent

PURPOSE. To determine the optimal intraocular pressure (IOP) values that contribute to stabilization of the course of the disease in patients with different stages of primary open-angle glaucoma (POAG) before and after surgery, depending on the current state of ocular biomechanical parameters.METHODS. This analytical descriptive scientific-clinical study analyzes the results of diagnostic studies conducted in the period from 2019 to 2022. The final protocol included 137 patients (209 eyes) with different stages of POAG. Two groups of patients were identified: the main group (105 patients, 156 eyes) with POAG, and the control group (32 patients, 53 eyes) — healthy individuals and patients with an established diagnosis of cataract. All patients underwent a thorough ophthalmological examination, including routine as well as special methods such as ophthalmotonometry in six different ways, bi-directional pneumatic applanation of the cornea, measurement of central corneal thickness (CCT). Additional decrease of the IOP level depending on the characteristics of the fibrous membrane of the eye was calculated using a simple regression followed by an assessment of the quality of the constructed model according to the calculated coefficients of determination (r2).RESULTS. The IOP values and biomechanical parameters of the fibrous membrane of the eye were analyzed depending on the stage of glaucoma process and the absence or presence of a history of surgical interventions for glaucoma in patient’s anamnesis. Significant differences in the viscoelastic parameters of the fibrous membrane of the eye were revealed between patients who had not undergone surgical treatment and those who had undergone one or two surgeries. Algorithms were developed to determine specific correction coefficients in order to correctly interpret the results of tonometry, taking into account the biomechanical characteristics of the membranes of the eye, and differences in target IOP were determined for groups of patients with different stages of POAG before and after surgical treatment.CONCLUSION. The results of this study demonstrate that the changing characteristics of the fibrous membrane of the eye in patients with glaucoma associated with previous surgical treatment can significantly distort the interpretation of data obtained using the basic ophthalmic tonometry. The study also shows that when choosing a «safe» range of IOP levels in patients with POAG, it is necessary to take into account patient’s history of penetrating surgical interventions. Thus, in single-operated patients, an additional decrease in IOP is required, on average by 1.7 mm Hg, while in repeatedly operated patients — by almost 3 mm Hg.

Technical difficulties of adequate assessment of intraocular pressure in a patient with glaucoma in the long term after corneal refractive surgery (clinical case)

PURPOSE. To demonstrate a clinical case involving difficulties in adequate assessment of intraocular pressure (IOP) in a patient with glaucoma in the long term after LASIK.METHODS. The study describes the case of patient M. of 58 years old with complaints about decreased distance vision in the right eye during the last year. In 2004 the patient underwent LASIK for moderate myopia. In 2018, asymmetry in the parameters of optic nerve head (size of the optic cup to the optic disc ratio (C/D ratio) was revealed: in the right eye — up to 0.7, narrowing of the visual field from nasal to fixation point; in the left eye — 0.5, visual fields without abnormalities. The IOP measured using the Maklakov method in both eyes corresponded to the average statistical norm — 22 mm Hg. The following diagnosis was established: IIA primary open-angle glaucoma in the right eye, IA primary open-angle glaucoma in the left eye. One-time instillations of latanoprost 0.005% eye drops solution was indicated for both eyes. In subsequent years the IOP was 18–20 mm Hg. After 4 years, the IOP according to the Maklakov method: OD — 18 mm Hg; OS — 21 mm Hg (on the hypotensive regimen — instillations of latanoprost 0.005% eye drops solution). In the right eye: C/D ratio 0.85–0.9 with absolute scotoma in the Bjerrum area 5–15° from fixation; in the left eye: C/D ratio 0.9 with neuro retinal rim loss from below, with absolute scotoma in the blind spot area. The stages of primary open-angle glaucoma were ascertained: IIIA in the right eye, IIA in the left eye.RESULTS. Selective laser trabeculoplasty was performed. Brimonidine 0.1% solution was added due to the lack of complete stabilization of the IOP level on a single instillation of latanoprost 0.005%, after that IOP decreased to 19 mm Hg in both eyes.CONCLUSION. It is necessary to carefully assess the condition of the structures of the optic nerve head in patients after LASIK, regardless of the statistically normal IOP values.

Relationship between corneal biomechanical indexes and optic disc morphometric indexes in patients with primary open angle glaucoma

Introduction. Glaucoma is a socially significant disease. With the advent of new technologies it has become possible to diagnose this disease at an earlier stage. The aim of the investigation was to reveal the relationships between biomechanical parameters of the optic nerve disc (OND) in patients with primary open-angle glaucoma (POAG) against the background of achieving the "target" intraocular pressure (IOP). Material and methods. A retrospective cohort study was conducted in which 51 patients with POAG were included. All patients underwent a standard ophthalmologic examination. Central corneal thickness and biomechanical parameters of the cornea were also evaluated. Optical coherence tomography (OCT) was performed to assess the state of the OND. Results and discussion. Goldman IOP levels had no differences depending on glaucoma stage, but corneal compensated IOP levels differed: the lowest IOP was detected in patients with advanced glaucoma, and the highest – in patients with far advanced glaucoma. Corneal hysteresis factor (CH) and corneal resistance factor (CRF) values also depended on the glaucoma stage: the highest – in initial, the lowest – in far advanced glaucoma. The coefficient of biomechanical tension of the fibrous membrane of the eye was the highest in the group of patients with advanced glaucoma. When assessing the correlation between corneal biomechanical properties and OND parameters, there was a positive correlation of CTR with the mean thickness of RNFL, RNFL thickness in the upper segment and neuroretinal band area (NRB), and a negative – with horizontal, vertical size and excavation area. Conclusion. This investigation demonstrated the correlation between corneal parameters (CCT, CH, CRF) and their derivatives: CH/CRF ratio, corneal biomechanical tension coefficient and corneal biomechanical coefficient characterizing IOP compensation degree and morphological parameters of the optic disk in POAG against the background of "target" IOP. Protective properties of a thicker cornea, higher indices of corneal hysteresis and corneal resistance factor to glaucoma progression were shown. Keywords: glaucoma, corneal hysteresis, opti

Commentary: Rethinking 10-2 visual fields in early diagnosis of glaucoma for a glided glaucoma practice: The right choice to pick up a feeble noise?

Commentary: Rethinking 10-2 visual fields in early diagnosis of glaucoma for a glided glaucoma practice: The right choice to pick up a feeble noise?

Comparative Evaluation of Activities of Daily Living Using Virtual Reality Simulation in Glaucoma and Non-Glaucoma Patients.

To compare the performance of activities of daily living (ADL) in Primary open-angle glaucoma patients and non-glaucoma normal controls using virtual reality (VR) simulation at the Lagos State University Teaching Hospital. This was a comparative clinical analysis involving primary open-angle glaucoma (POAG) patients. A total of 86 patients were enrolled (43 cases and 43 normal non-glaucoma). Each participant completed four VR simulation tasks. Chi-square/Fisher exact test was used to compare variables. The confidence interval was set at 95% for all statistical tests, and a P value of <0.05 was considered significant. The mean age of participants in the glaucoma group was 60.3 years, and the mean age in the normal non-glaucoma group was 56.5 years. The number of clicks in the driving task in the normal non-glaucoma and glaucoma group differed by 4.84 clicks (mean normal 21.00, confidence interval [CI], 19.96-22.14, mean glaucoma 16.16, CI, 14.30-18.03, P < 0.001). The number of newspapers seen differed by 0.88 (mean normal 9.74, CI, 9.40-10.09; mean glaucoma 8.86, CI, 8.21-9.51, P = 0.020). The mean time taken to complete the bus stop simulation task differed by 41.23 s (mean normal 29.72 s, CI, 25.02-34.42; mean glaucoma, 70.95 s, CI, 53.26-88.65, P < 0.001). The mean time taken to complete the best dress task differed by 14.39 s (mean normal 9.49, CI, 8.18-10.80; mean glaucoma 23.88, CI, 10.03-37.74, P = 0.038). Patients with advanced and severe stages of glaucoma took longer to complete the VR task than those with early glaucoma. The VR simulation used in assessing the performance of ADL among POAG participants highlights limitations that vary with varying severity of glaucoma. The conventional clinical investigation used in assessing glaucoma severity might not define the real-time social effect of the disease.

DEEP PERONA–MALIK DIFFUSIVE MEAN SHIFT IMAGE CLASSIFICATION FOR EARLY GLAUCOMA AND STARGARDT DISEASE DETECTION

Glaucoma and Stargardt’s, an inherited disease predominantly affect the retinal portion of the eye. The diagnosis of Glaucoma in a fundus image is an arduous, time consuming process. There were many research works carried out to detect early stages of Glaucoma and Stargardt’s disease. However, the accuracy, diagnostic time and performance were not improved. To resolve the above said problems, a computational method called Deep Neural Perona–Malik Diffusive Mean Shift Mode Seeking Segmented Image Classification (DNP-MDMSMSIC) is introduced for the early detection of Glaucoma and Stargardt’s disease with retinal fundus images. The DNP-MDMSMSIC method comprises diverse types of layers that support to identify early detection of disease with improved accuracy and less time. Process as explained; initially, numerous qualified retinal images are given as input to the input layer. These input images are transmitted further to the hidden layer 1 to perform image pre-processing. In DNP-MDMSMSIC, Space-Variant Perona–Malik Diffusive Image Preprocessing is carried out to decrease the noise from input image without removing contents like edges, lines, etc., for image interpretation with a higher peak signal-to-noise ratio. This preprocessed image is further processed in the hidden layer 2 where the feature extraction process is performed to extract features like color, texture, and intensity with a higher degree of accuracy. Based on the extracted features, an input feature image gets segmented in hidden layer 3. Mean Shift Mode Seeking Segmentation algorithm is employed to segment the pixels in image space with corresponding feature space points. Then the segmented images are given to the output layer to perform retinal fundus image classification using Bregman Divergence Function. During the image classification, the distance between two segmented regions (i.e., testing image region of particular class and training image region) with convex is measured. In this way, the retinal fundus images get classified with higher accuracy. Experimental evaluation is performed by considering the metrics such as peak signal-to-noise, disease detection accuracy, disease detection time, and error rate corresponding to the number of retina fundus images and image size. DNP-MDMSMSIC method is designed to detect Glaucoma and Stargardt’s disease at an earlier stage with higher accuracy by 8% and less time by 20% with aid of ACRIMA database.

Glaucoma in Adults-diagnosis, Management, and Prediagnosis to End-stage, Categorizing Glaucoma's Stages: A Review.

Most frequent worldwide cause of permanent blindness is glaucoma. Early in the course of the disease, glaucoma affects many patients without any symptoms. In order to examine for indications of glaucoma and to ascertain whether systemic illnesses or drugs can raise a patient's risk of developing glaucoma, primary care practitioners should be aware of which patients to send to an eye care specialist. A review of the pathogenesis, risk factors, screening, disease monitoring, and treatment options for open-angle and narrow-angle glaucoma are included. The optic nerve and retinal nerve fiber layer (rNFL) are damaged in glaucoma, a chronic, progressive optic neuropathy that can result in a permanent loss of peripheral or central vision. The only risk factor that is known to be controllable is intraocular pressure (IOP). A family history of glaucoma, older age, and non-white race are additional significant risk factors. Numerous systemic diseases and drugs, such as corticosteroids, anticholinergics, certain antidepressants, and topiramate, can put people at risk of developing glaucoma. Open-angle and angle-closure glaucoma are the two main types of disease. Measurement of IOP, perimetry, and optical coherence tomography are diagnostic procedures to evaluate glaucoma and track the course of the condition. In order to treat glaucoma, IOP must be decreased. This is possible with a variety of glaucoma medication classes, laser surgery, and incisional surgery. By identifying systemic illnesses and drugs that raise a patient's chance of developing glaucoma and referring high-risk individuals for a thorough ophthalmologic examination, vision loss from glaucoma can be reduced. Clinicians should make sure that patients continue taking their glaucoma drugs as prescribed and should keep an eye out for any negative side effects from any medical or surgical procedures used to treat glaucoma. Joshi P, Dangwal A, Guleria I, et al. Glaucoma in Adults-diagnosis, Management, and Prediagnosis to End-stage, categorizing Glaucoma's Stages: A Review. J Curr Glaucoma Pract 2022;16(3):170-178.

Differentiating stages of functional vision loss from glaucoma using the Disc Damage Likelihood Scale and cup:disc ratio

BackgroundGlaucoma staging is critical for treatment planning but has rarely been tested in severe/end-stage disease. We compared the performance of the Disc Damage Likelihood Scale (DDLS) and cup:disc ratio (CDR)...

Use of multifocal electroretinograms to determine stage of glaucoma.

To determine whether multifocal electroretinograms (mfERGs) recorded with natural pupils and skin electrodes can be used to determine the stage of open angle glaucoma (OAG). Two hundred eighteen eyes of 132 OAG patients and 62 eyes of 62 normal subjects whose best-corrected visual acuity (BCVA) was 0.1 logarithm of the minimum angle of resolution (logMAR) units (20/25) or less were studied. The mean deviations (MDs) obtained by Humphrey Visual Field Analyzer (HFA), optical coherence tomographic (OCT) images, and mfERGs were analyzed. The glaucoma was classified into 4 stages: preperimetric glaucoma (PPG), early stage, moderate stage, and advanced stage glaucoma. The parameters of the mfERGs examined were the amplitudes of the two positive peaks (P1, P2) of the second order kernels in the nasal and temporal fields within the central 15° diameter. The mean age of all participants (patients and normals) was 63.8 ± 10.8 years. With the progression of glaucoma, the amplitudes of P1 in the nasal hemifield increased and the amplitudes of P2 decreased. The nasal to temporal ratio (N/T ratio) of the P1 amplitudes and the negative slope of the line between P1 and P2 (P1P2 Slope) in the nasal field were larger at each glaucoma stage except at the PPG stage. Both the N/T amplitude ratio and P1P2 Slope were weakly but significantly correlated with the MD (r = -0.3139, P<0.0001; r = 0.4501, P<0.0001, respectively), and the OCT parameters (all P<0.0001) except the outer layer thickness. Our findings indicate that the amplitudes of P1 and P2 of the second order kernel of the mfERGs in the nasal field of the center region can be good markers for the stages of glaucoma.

Ganglion Cell Complex Analysis: Correlations with Retinal Nerve Fiber Layer on Optical Coherence Tomography.

The aim of this review is to analyze the correlations between the changes in the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) on optical coherence tomography in different possible situations, especially in eyes with glaucoma. For glaucoma evaluation, several studies have suggested that in the early stages, GCC analysis, especially the thickness of the infero and that of the inferotemporal GCC layers, is a more sensitive examination than circumpapillary RNFL (pRNFL). In the moderate stages of glaucoma, inferior pRNFL thinning is better correlated with the disease than in advanced cases. Another strategy for glaucoma detection is to find any asymmetry of the ganglion cell-inner plexiform layers (GCIPL) between the two macular hemifields, because this finding is a valuable indicator for preperimetric glaucoma, better than the RNFL thickness or the absolute thickness parameters of GCIPL. In preperimetric and suspected glaucoma, GCC and pRNFL have better specificity and are superior to the visual field. In advanced stages, pRNFL and later, GCC reach the floor effect. Therefore, in this stage, it is more useful to evaluate the visual field for monitoring the progression of glaucoma. In conclusion, GCC and pRNFL are parameters that can be used for glaucoma diagnosis and monitoring of the progression of the disease, with each having a higher accuracy depending on the stage of the disease.

Предпочтения практикующих российских врачей-офтальмологов при определении стратегии лечения пациентов с первичной открытоугольной глаукомой (результаты многоцентрового научно-аналитического исследования)

The aim of the study was to establish the preferences of domestic ophthalmologists in the selection of prescribing schemes and approaches in the treatment of patients with different stages of primary open-angle glaucoma (POAG). The results of a questionnaire survey of 472 ophthalmologists conducted during the period from August to November 2022 were analyzed. The main part of the questionnaire contained questions concerning the preferences of specialists in selecting the tactics of treatment of patients with glaucoma, for example, treatment schemes for patients with different stages of POAG, including priorities of particular prescriptions (groups of drugs and other approaches), details of current clinical practice — patients' compliance with the prescribed treatment and its cost, expediency of using combined antiglaucoma drugs in the form of their fixed combinations (FC), as well as preservative-free drugs. It was established that 328 (69.5%) ophthalmologists prefer to use the possibility of combined mechanism of action of antiglaucoma hypotensive drugs, 92 (19.5%) - the possibility of targeted influence on uveoscleral outflow. In patients with the initial stage of glaucoma the prescription of monotherapy with the use of prostaglandin analogs (PGAs) is used, in persons with the advanced stage of glaucoma the priority in the prescription of combined forms of drugs is determined, and at the highly advanced stage of the disease surgical treatment is performed. Polypragmasy in prescriptions of antiglaucoma topical drugs impedes effective treatment, and in this regard, ¾ of respondents were in favor of a more active use of FC drugs, considering their use more justified to achieve the goal of treatment than the use of separate prescription schemes. The use of preservative-free forms of drugs allows to keep the ocular surface of glaucoma patients intact for a long time, to predict the results of the expected (and imminent) surgical treatment and to increase the compliance to treatment. The results of the study indicate a confident adherence of ophthalmologists to the guidelines of current clinical recommendations when choosing drug regimens and treatment regimens in patients with different stages of glaucoma.

Клинико-морфологическая характеристика глаукомной оптической нейропатии при различных стадиях вторичной глаукомы у собак

This paper presents a correlation between the clinical and histomorphological picture, as well as electrophysiological data characteristic of different stages of glaucoma optic neuropathy in dogs. Glaucoma is a common disease among small pets, in particular dogs, leading to impaired visual functions and blindness, which significantly reduces the quality of life of the animal. Blindness develops due to increased intraocular pressure, which leads to damage to various layers of the retina, the optic nerve disc and microcirculation disorders. Therefore, the main task in the treatment of dogs with glaucoma is the preservation of visual functions. In this work, a study was conducted to assess the clinical picture in 60 dogs with various stages of glaucoma, as well as in 18 dogs, a histomorphological study was also conducted with various stages of the glaucoma process. As a result of the conducted studies, clinical manifestations of fundus changes in the glaucomatous process in dogs have been identified and substantiated. It is shown that the clinical manifestation of glaucomatous lesion is polymorphic and depends on the severity of the course and duration of the disease. The established correlation between the data of ophthalmoscopy, fundoscopy, electroretinography and histomorphology allows classifying the disease into three stages: initial (from 1 to 5–7 days), advanced (from 7 to 30–45 days) and terminal (more than 30–45 days). Objective diagnostic symptoms of glaucomatous lesions of the posterior segment of the eyeball are: paleness of the ZEN and expansion of the excavation of the ZEN, a decrease in the neuroretinal girdle, thinning of retinal vessels, hyperreflexia of the tapetal zone.

Compatibility of peripapillary choroidal thickness measurement between 4-point manual measurement and measurement by manual re-segmentation in eyes with and without glaucoma

Aim: To evaluate the compatibility of peripapillary choroidal thickness (PPCT) using 4-point manual measurement and measurement by manual re-segmentation in glaucomatous and nonglaucomatous eyes. Materials and Methods: A total of 270 eyes of 135 consecutive patients were included in the study. Of these, 79 eyes had glaucoma. OCT images of peripapillary circle scans were investigated with Heidelberg Spectralis OCT. PPCT at the 3.4 mm circular line around the disc was measured by 2 techniques; manual 4-point measurement (PPCT-1) at temporal, superior, nasal and inferior sectors and by changing retinal nerve fiber layer (RNFL) segmentation lines manually using the editing function and obtaining automatic calculations (PPCT-2). Compatibility of the 2 techniques and correlations with RNFL measurements, age, sex, glaucoma presence, glaucoma drug usage, glaucoma stage, mean deviation, spherical equivalent (SE) and corneal thickness were investigated. Results: Mean PPCT measured with the PPCT-1 technique was 149.44 ± 2.84 µm, while with the PPCT-2 technique, it was 159.51 ± 2.72 µm (p&lt;0.001). There was a statistically strong positive correlation between PPCT-1 nasal and PPCT-2 nasal values (R: 0.875). Negative correlations were found between the 2 methods with age, SE, glaucoma stage and glaucoma drug usage. Conclusion: Both of the measurement techniques are useful to evaluate PPCT.

Отдельные результаты пострегистрационного наблюдательного исследования по оценке клинической эффективности и переносимости терапии препаратами Бимикомби Антиглау ЭКО и Брим Антиглау ЭКО у пациентов с разными стадиями первичной открытоугольной глаукомы в реальной клинической практике (Brim Bimicombi Antiglau real World Ophthalmology, BRAWO)

Aim: to assess the clinical efficacy and tolerability of bimatoprost/timolol (Bimicombi Antiglau ECO) and brimonidine (Brim Antiglau ECO) in different stages of primary open-angle glaucoma (POAG) compared with prior therapy. Patients and Methods: data from 1036 patients were included in the final protocol of the multicenter combined scientific and clinical study. All patients were diagnosed with POAG or were glaucoma suspects (GS) with ocular hypertension (OHT). All patients underwent a complex eye examination. Treatment with the drugs studied should have lasted 2 to 4 months. Treatment choice resulted from the lack of efficacy, ineffectiveness, or intolerance of prior therapies. The control study was conducted once not less than a month after inclusion in the study. Results: POAG (any stage) was diagnosed in 982 patients (94.8%), and GS with OHT were 54 patients (5.2%). Changing treatment regimen (in a planned manner) prevented tachyphylaxis and tolerance to previously prescribed drugs, which was established by IOP measurements (a 20% reduction in IOP compared with prior data). If the regimen was changed for any reason (overall, 6 reasons were analyzed), three most common reasons were poor clinical efficacy (36.6%), discomfort (26.6%), and poor tolerability (23.9%). Prescription of preservative-free IOP-lowering medications (eye drops studied) for 1 month after the washout period significantly (by 19 times) reduced the number of these complaints. Preservative-free medications significantly increase the maximum satisfaction with prescribed treatment regimens (Likert score 4.61 of 5) and largely meet the expectations of doctors in terms of drug efficacy and tolerability (Likert score 4.67 of 5). Conclusion: preservative-free IOP-lowering medications (eye drops studied) are effective and well tolerated. KEYWORDS: glaucoma therapy, efficacy, tolerability, bimatoprost/timolol, brimonidine, primary open-angle glaucoma, real-world clinical practice, BRAWO. FOR CITATION: Kuroyedov A.V., Kosakovskaya M.V., Gapon'ko O.V., Gorodnichiy V.V., Lovpache D.N., Bulakh I.A. Selected results of a post- registration observational study on the clinical efficacy and tolerability of Bimicombi Antiglau ECO and Brim Antiglau ECO in different stages of primary open-angle glaucoma in real-world clinical practice (Brim Bimicombi Antiglau Real World Ophthalmology, BRAWO). Russian Journal of Clinical Ophthalmology. 2023;23(3):129–135 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-4.

L- and T-type Ca2+ channels dichotomously contribute to retinal ganglion cell injury in experimental glaucoma.

Retinal ganglion cell apoptotic death is the main pathological characteristic of glaucoma, which is the leading cause of irreversible blindness. Disruption of Ca2+ homeostasis plays an important role in glaucoma. Voltage-gated Ca2+ channel blockers have been shown to improve vision in patients with glaucoma. However, whether and how voltage-gated Ca2+ channels are involved in retinal ganglion cell apoptotic death are largely unknown. In this study, we found that total Ca2+ current densities in retinal ganglion cells were reduced in a rat model of chronic ocular hypertension experimental glaucoma, as determined by whole-cell patch-clamp electrophysiological recordings. Further analysis showed that L-type Ca2+ currents were downregulated while T-type Ca2+ currents were upregulated at the later stage of glaucoma. Western blot assay and immunofluorescence experiments confirmed that expression of the CaV1.2 subunit of L-type Ca2+ channels was reduced and expression of the CaV3.3 subunit of T-type Ca2+ channels was increased in retinas of the chronic ocular hypertension model. Soluble tumor necrosis factor-α, an important inflammatory factor, inhibited the L-type Ca2+ current of isolated retinal ganglion cells from control rats and enhanced the T-type Ca2+ current. These changes were blocked by the tumor necrosis factor-α inhibitor XPro1595, indicating that both types of Ca2+ currents may be mediated by soluble tumor necrosis factor-α. The intracellular mitogen-activated protein kinase/extracellular signal-regulated kinase pathway and nuclear factor kappa-B signaling pathway mediate the effects of tumor necrosis factor-α. TUNEL assays revealed that mibefradil, a T-type calcium channel blocker, reduced the number of apoptotic retinal ganglion cells in the rat model of chronic ocular hypertension. These results suggest that T-type Ca2+ channels are involved in disrupted Ca2+ homeostasis and apoptosis of retinal ganglion cells in glaucoma, and application of T-type Ca2+ channel blockers, especially a specific CaV3.3 blocker, may be a potential strategy for the treatment of glaucoma.

Morphological evaluation of the results of laser activation of scleral hydropermeability in the treatment of glaucoma

The study attempted to experimentally substantiate the possibility of using the laser activation of scleral hydropermeability (LASH) technique in glaucoma treatment by morphological evaluation of treatment outcomes. The pulsed-periodic radiation from an Er-glass fiber laser (λ=1.56 μm) was used. The model experiment consisted of evaluating ultrafiltration of fluid through the tissues of human sclera autopsy specimen according to the original technique using neodymium chloride-based labeling agent and scanning electron microscopy. The clinical part of the study consisted of optical coherence tomography (OCT) and laser confocal microscopy of the sclera and conjunctiva (CMSC) performed in vivo immediately after laser treatment in the laser application sites in 5 patients (5 eyes) aged 57 to 68 years with uncompensated advanced (IIIb-c) stage of glaucoma who had previously underwent LASH surgery. Results of morphological evaluation after LASH revealed structural changes indicating increased transscleral ultrafiltration: increased intrastromal hyporeflective areas in the sclera, thinning of collagen fibers, formation of porous structures. Using an original technique involving neodymium chloride-based labeling agent and scanning electron microscopy, we were able to prove the enhancement of transscleral ultrafiltration. The results of the experiment were confirmed by in vivo OCT images of the sclera and CMSC performed in 5 patients with advanced glaucoma after LASH surgery, in which tissue decompaction in the laser-exposed areas was clearly visualized. The revealed structural changes indicate the possibility of reducing intraocular pressure after LASH by the means of forming scleral porous structures and increasing transscleral ultrafiltration. Experimentally selected optimal mode of laser exposure (0.66 W with total exposure time of 6 seconds) during LASH helps avoid gross destructive changes in the eye tissues, making the proposed intervention a sparing approach to the treatment of glaucoma.