Stages Of Primary Open-angle Glaucoma Research Articles

The potential of a fixed combination of brimonidine and timolol in achieving safe intraocular pressure levels after micropulse laser cyclophotocoagulation

PURPOSE. To evaluate the clinical effectiveness and safety of using a fixed combination — hypotensive drug Brimonidine Duo (brimonidine tartrate 2 mg/mL + timolol maleate 5 mg/mL) to reduce intraocular pressure in patients with advanced stages of primary open-angle glaucoma (POAG) in cases when achieving target pressure failed after laser micropulse transcleral diode laser cyclophotocoagulation (mCPC).METHODS. MCPC was performed with individually chosen parameters in 100 patients (104 eyes) aged 35 to 86 with POAG, of them 54.17% were men and 45.83% were women. The follow-up period lasted 3 months, the results were evaluated on the 1st, 7th and 14th days, then after 1 and 3 months. In 23.08% of cases (24 patients) subjects were prescribed antihypertensive combination drug Brimayza Duo due to intraocular pressure (IOP) remaining uncompensated.RESULTS. The average IOP level after 7 days was 23.54± 4.8 mm Hg. After 3 months, IOP values were 18.11±2.04 mm Hg, which is 4–5 mm Hg lower than in the early postoperative period. After 30 days of follow-up, an additional antihypertensive drug Latanoprost 0.005% was added for 5 patients (20.83%). Repeated surgery was recommended and performed in 4 patients (16.67%), of which 1 patient underwent surgical intervention of the penetrating type, 3 patients underwent repeat mCPC with individually chosen parameters.CONCLUSION. MCPC is a safe and effective tool for reducing intraocular pressure in patients with advanced stages of POAG. The noninvasive nature of this technique makes it possible to speed up the recovery time after surgery, as well as reduce the number of postoperative complications. Among patients who failed to achieve target pressure after surgery, the use of Brimayza Duo was effective in 62.5% of cases.

The investigation of the association of alleles and genotypes of the polymorphic marker T786C of the eNOS gene at various stages of primary open-angle glaucoma

Purpose: to study the association of the polymorphic marker T786C of the eNOS gene with various stages of primary open-angle glaucoma (POAG).Materials and methods. Peripheral blood of 90 patients aged 56 to 89 yrs (ave. 71 yrs) with POAG stages I, II, III was tested. DNA was isolated using a set of ribosorbents (Synthol company); subsequently, a real-time PCR reaction was performed on a DT-96 amplifier using the set to determine the polymorphic marker T786C in the eNOS gene.Results. For all groups of patients, the frequency of occurrence of alleles and genotypes was calculated, and the relationship between the emergence of POAG and the presence of an unfavorable polymorphic marker was determined. The main changes were revealed at POAG stages II and III, whilst at stage I no effect of polymorphism T786C of the eNOS gene was observed.Conclusion. For the first time, a comparative assessment was made of the distribution of alleles and genotypes by the polymorphic marker T786C in the eNOS gene of patients with various POAG stages.

The influence of post-COVID-19 syndrome on microcirculation of the optic nerve head among patients with primary open-angle glaucoma

BACKGROUND: Glaucoma is one of the leading causes of blindness in the world. This is a multifactorial ophthalmopathology, which also results from impaired microcirculation in the optic nerve. One of the diseases affecting ocular blood flow is acute coronavirus infection (COVID-19).
 AIM: The aim of this study is the assessment of blood flow parameters of the optic nerve head in patients with primary open-angle glaucoma (POAG) against the background of post-COVID-19 syndrome using laser speckle flowgraphy.
 MATERIALS AND METHODS: The study included 40 patients with advanced stage primary open-angle glaucoma who had COVID-19 within the previous 3 months. Patients were divided into 2 subgroups depending on the severity of the disease. The comparison group consisted of 20 individuals with an advanced stage of primary open-angle glaucoma who did not have COVID-19. All subjects were over 60 years old and had normal blood pressure parameters. Optic nerve head blood flow was measured using the LSFG-NAVI device (Japan) and assessed by LSFG Analyzer software. MBR parameters (MA, MV and MT), as well as pulse wave indicators (Skew, BOS, BOT, RR, FR, FAI, ATI and RI) were analyzed.
 RESULTS: The most significant decrease was found for the MV and MT parameters, reflecting the blood flow in large vessels and the microvasculature of the optic disc. MV decrease by 20%, MT — by 23%, MA — by 16% were noted, as well as pulse wave parameter changes, in patients with an advanced stage of primary open-angle glaucoma, post-COVID syndrome after moderate COVID-19 compared with patients with an advanced stage of primary open-angle glaucoma who did not have COVID-19 (p ≤ 0.05).
 CONCLUSIONS: Laser speckle flowgraphy allows rapid and effective assessment of ocular blood flow. Parameters estimated at the examination may be considered as new biomarkers for the detection and evaluation of vascular diseases.

Factors affecting the hypotensive effect of selective laser trabeculoplasty in primary open-angle glaucoma

This study analyzes the influence of various factors on the hypotensive effect of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). A retrospective study of the SLT effect was performed in 582 patients (756 eyes; mean age - 71.9±9.5 years) with POAG stages I-III. The level of intraocular pressure (IOP) decrease was assessed at 1 day, 1, 3, 6, and 12 months after SLT. The relationship between the hypotensive effect and age, gender, glaucoma stage, initial IOP level, number and type of instilled drugs, presence of intraocular lenses, and the surgeon performing the intervention were analyzed. In the entire sample, the hypotensive effect of SLT after 1 day was 4.1±3.4 mm Hg, after 1, 3, 6, and 12 months - 3.7±4.8; 3.5±3.8; 3.1±3.4 and 2.3±3.8 mm Hg, respectively. The hypotensive effect of SLT was most dependent on the preoperative IOP level (R>0.64, p<0.05). No significant correlation was found between the hypotensive effect and the stage of POAG, gender, age, number of hypotensive drugs, phakia/aphakia, and the surgeon. A weaker hypotensive effect of SLT was found in eyes receiving monotherapy with α2-adrenoceptor agonists (p<0.03) and a combination of four drugs (p<0.02). SLT is an effective method of additional IOP reduction in POAG at any stage and with any hypotensive regimen. At the same time, the results of its use in real clinical practice indicate the need for more careful IOP control after the procedure, especially in eyes with POAG stage III, as well as in eyes without hypotensive therapy and on the maximum drop regimen.

Early impairment of magnocellular visual pathways mediated by isolated-check visual evoked potentials in primary open-angle glaucoma: a cross-sectional study

ObjectiveTo explore different performances in the magnocellular (MC) and parvocellular (PC) visual pathways in patients with primary open-angle glaucoma (POAG) and to objectively assess impairment in early stage of POAG.Methods...

Distal Nasal Part of the Visual Field and RNFL in Primary Open-Angle Glaucoma.

The aim of this study was to compare changes in the conventionally undiagnosed distal nasal visual field with RNFL in patients with early primary open-angle glaucoma (POAG). 59 eyes of 32 patients (18 women, 14 men) with early stage POAG were included. All eyes were found to have a normal visual field (fast threshold program of 50 degrees nasally and 22 degrees temporally) with the Medmont M700. Visual acuity was 1.0 (with a possible correction ±3 D), and they had no other ocular pathology except glaucoma. The visual field was subsequently examined with the same instrument by moving the fixation point 40 degrees temporally (spatially adaptive program) and simultaneously turning the head 10 degrees nasally. A total of 89 examination points were included using flicker stimuli in a range of 0-120 degrees nasally. Nerve fiber layer (RNFL) and vessel density (VD) was measured using the in-built software of the Avanti RTVue XR instrument. Using Pearson's correlation coefficient, the results of visual field examination with RNFL without and after correction (by subtracting VD from total RNFL value) in the superior-nasal (SN-5) and inferior-nasal (IN-8) segments were compared. In all eyes, changes were found in the distal periphery of the nasal part of the visual field. No correlation was noted by comparison with RNFL. After adjusting RNFL for VD, we observed no correlation in the SN segment (5) (r=-0.03) and a very weak correlation in the IN segment (8) (r=-0.16). With a normal visual field tested by the rapid threshold glaucoma program, changes in the distal part of the nasal periphery of the visual field were found in the entire cohort and did not correlate with the RNFL and RNFL results after correction from VD.

Efficacy and safety of the initial hypotensive treatment with an optimized latanoprost composition

Purpose: a comparative study of the efficacy and safety of Latanoprost-Optic, a new composition of excipients and the original latanoprost, in the initial therapy of primary open-angle glaucoma (POAG)Material and methods. We performed a prospective, randomized, comparative study of 60 previously untreated patients (71 eyes) with early and advanced POAG stages. During the screening visit, patients were randomly divided into the main (Latanoprost-Optic) and the control (original latanoprost) groups. The target points included intraocular pressure (IOP), visual acuity, MD and PSD perimetry indices, RNFL thickness, MRW, NFL, GCL, IPL, tear film break time, OSDI, and adverse events. The observation period was 12 weeks. IOP was measured 4 and 12 weeks from observation start.Results. The average decrease in IOP in the study group by the end of the observation was 32% and did not show any statistically significant differences from the original drug at any control point. A positive unreliable dynamic of the values of most functional parameters was noted, which may indicate the presence of an indirect neuroprotective effect. In the study group, there was a positive trend in tear film rupture time and OSDI. According to corneal confocal microscopy, no negative changes in dynamics were noted, in contrast to the control group. Reversible discomfort and mild redness of the bulbar conjunctiva were recorded in both groups. No serious or systemic adverse events were noted.Conclusion. Latanoprost-Optic has a hypotensive efficacy, comparable to the original latanoprost, and a high favorable safety profile.

Possibilities of Preservative-Free Therapy for Primary Open-Angle Glaucoma

Purpose: to evaluate the efficacy and safety of preservative free travoprost generic in primary open-angle glaucoma patients. Patients and methods. 40 patients with compensated primary open-angle glaucoma (POG) and dry eye (DE) were examined: 1st group (20 patients) with the initial stage of POG (travoprost with a preservative monotherapy), 2nd group with an advanced stage of POG (travoprost with a preservative in combination therapy). In all patients, travoprost with a preservative was replaced with preservative free travoprost (Traviolan, 1 time per day, in the evening). Control: 1 — when included in the study; 2 — 4 weeks after replacing travoprost with a preservative for preservative free travoprost. Efficiency criteria: absence of negative dynamics of intraocular pressure (IOP) and MD and PSD perimetric indices (dB; Optos). Safety criteria: absence of OSDI (scores), tear film brake up time (TBUT; Norn’s test, s), lower tear meniscus height (LTMH, µm; OptoVue) and Bijsterveld’s xerosis index (XI, scores) negative dynamics. Results. At the 2nd control point, all observed did not have a statistically significant dynamics of IOP, MD, PSD. In patients of both groups, at the 2nd control point, there was the OSDI and TBUT statistically significant positive dynamics, and in patients of the 1st group — XI statistically significant positive dynamics. The trend towards to XI decreasing in 2nd group patients and the LTMH dynamics in both groups turned out to be statistically insignificant. Conclusion. Preservative free travoprost has shown efficacy comparable to that of travoprost with preservative in both monotherapy and combination therapy. Significant positive dynamics of OSDI and TBUT in patients of both groups and XI in 1st group patients after switching to preservative free travoprost indicates a good “safety profile” of therapy in terms of its effect on the ocular surface state in DE conditions, which, from our point of view, may contribute to maintaining the “quality of life” and patients compliance.

Селективная лазерная трабекулопластика (СЛТ) после антиглаукомной хирургии при развитой и далеко зашедшей первичной открытоугольной глаукоме

Purpose. To study the hypotensive effect of selective laser trabeculoplasty (SLT) treatment in cases of insufficient effectiveness or reduced hypotensive effect of glaucoma surgery in patients with moderate and advanced primary open-angle glaucoma (POAG). Material and methods. A retrospective study was conducted of 32 patients (32 eyes) with POAG after previous glaucoma surgery and uncompensated intraocular pressure (IOP), who underwent SLT due to the impossibility of reoperation. Changes in IOP were studied 1 day, 1, 3, 6 and 12 months after SLT. Results. After SLT, the IOP level decreased from 24.5±4.4 to 19.3±3.8 mm Hg after 1 day (p&lt;0.001), the hypotensive effect was 5.2±5.1 mm Hg (21.2% of the baseline IOP) and did not change significantly within 3 months after laser treatment. After 6 and 12 months, a decrease in the hypotensive effect was revealed compared with the primary response 1 day after SLT (3.0±2.9 and 1.9±5.4 mm Hg, p=0.02). 12 months after SLT, the IOP level remained below the baseline IOP only in 46.9% of cases. There were no significant differences in the results of SLT at different stages of POAG, different types of glaucoma surgery, different medication regimens (p&gt;0.05), and there was no dependence on the timing after previous glaucoma surgery. Conclusion. SLT can be used after previous glaucoma surgery when IOP reduction is insufficient in patients with moderate and advanced POAG. However, the hypotensive effect of SLT in such cases is unstable, so this method of treatment should be considered only as an auxiliary one and if repeated surgery is not possible, as well as providing more frequent control of IOP in patients. Key words: glaucoma, selective laser trabeculoplasty, intraocular pressure, glaucoma surgery, ophthalmic surgery

Correlations between peripapillary retinal nerve fiber layer thickness and macular thickness in different stages of primary open-angle glaucoma, an OCT study

Correlations between peripapillary retinal nerve fiber layer thickness and macular thickness in different stages of primary open-angle glaucoma, an OCT study

Изучение эффективности лечения эндотелиальной сосудистой дисфункции при различных стадиях первичной открытоугольной глаукомы

Relevance. According to literary sources, POAG is considered as a chain of interaction of etiological and pathogenetic factors, among which the leading role is played by genetic predisposition, general changes, ischemia, primary local functional and dystrophic changes, disturbances in hydrostatics and hydrodynamics of the eye, increased intraocular pressure, vascular disorders, dystrophy and tissue degeneration. Purpose of the study. To assess the severity of endothelial dysfunction in patients with different stages of primary open-angle glaucoma during complex therapy. Material and research methods. The study included 92 patients with POAG aged 65 to 80 years, who were divided into three groups. We studied the levels of endothelin-1, VEGF and von Willebrand factor before and after the recommended treatment in patients with POAG. Conclusion. The developed complex therapy of various stages in patients with POAG contributed to the correction of the identified disorders in relation to markers of endothelial dysfunction. The features of changes in ED markers in patients with POAG have been established; low levels of von Willebrand factor, VEGF and endothelin-1, which indicates the role of pathogenetic factors in the formation of endothelial dysfunction and the importance of studying markers of endothelial dysfunction. Keywords: primary open-angle glaucoma, endothelial markers, von Willebrand factor, VEGF, endothelin-1, complex therapy

Сравнительные результаты микроимпульсной циклофотокоагуляции с учетом различных уровней энергии у пациентов с первичной открытоугольной глаукомой

Purpose. To evaluate the safety and efficacy of different laser energy parameters when performing micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with different stages of primary open-angle glaucoma (POAG). Material and methods. 177 patients with moderate (47) and advanced (130) stages of primary open-angle glaucoma were under observation. All patients underwent repeated laser (mean 1,3±0,6) and surgical (mean 1,78±0,7) penetrating and nonpenetrating antiglaucoma surgeries. According to the amount of total energy during MP-TSCPC, patients were divided into 2 groups. The protocol of the first group (117 patients) included a total energy of 125J, fluence of 121,8 J/cm² . The protocol of the second group included increased energy (60 patients) where the total energy was 150 J, fluence 152 J/cm² . Results. Surgery and postoperative period in all patients were areactive. According to the data obtained when comparing the two groups on Kaplan – Meier chart, after 12 months of observation the group of patients with the fluence of 152J/cm² showed better results. A positive result was achieved in 95% of cases, compared to 87,1% in patients in the first group with an fluence of 121,8 J/cm². Conclusion. MP-TSCPC in patients with POAG with a fluence of 121,8 J/сm² and a total energy of 125 J and a fluence of 152 J/сm² and a total energy of 150 J is an effective and safe treatment method. The success parameters evaluated according to the Kaplan – Meier criterion showed that performing MP-TSCPC with 150 J energy was more effective than with 125 J. In the first group, 87,1% (102 out of 117 patients) success was achieved in up to 12 months of follow-up. In 60 patients with a higher energy (150 J), MP-TSCPC resulted in a long-term hypotensive effect in 95% (57 out of 60 patients) in the same period of observation. Key words: open angle glaucoma, intraocular pressure, micropulse cyclophotocoagulation, fluence

Macula vessel density and its relationship with the central visual field mean sensitivity across different stages of exfoliation glaucoma

ABSTRACT Clinical relevance Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma. Background This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages. Methods In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature–function and structure–function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately. Results The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p = 0.9). The macula vessel density (%)–visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes (r = 0.464 p = 0.01), while no such correlation was notable for the early stage POAG eyes (r = –0.029 p = 0.89). Conclusion The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.

Местное хроническое асептическое воспаление в патогенезе первичной открытоугольной глаукомы (пОУГ), роль дисбаланса биологически активных молекул

Purpose. Purpose: to study the content of pro-inflammatory cytokines and matrix metalloproteinases in the intraocular fluid in patients with advanced stage of primary open-angle glaucoma. Material and methods. 50 patients were examined with a verified diagnosis of the advanced stage of poag. the control group consisted of 30 patients with a diagnosis of uncomplicated cataract. the concentration of the determined biologically active molecules was carried out by the method of flow fluorimetry on a two-beam laser analyzer -Bio-plex 200, Bio-rad, USA. Results. A statistically significant increase in the concentrations of Il-6, 8, 12, 17, mIp-1β matrix metalloproteinase-2 was found in the intraocular fluid of patients with poag. Conclusion. The data obtained indicate the significance of the local inflammatory process, as well as disturbances in the structure of the extracellular matrix in the mechanisms of poag development. Keywords: primary open-angle glaucoma, intraocular fluid, cytokines, matrix metalloproteinases

Topical hypotensive therapy preceding surgical treatment of glaucoma

PURPOSE. To analyze specific clinical and epidemiological parameters of patients with primary open-angle glaucoma (POAG) who were admitted for surgical treatment to the ophthalmological hospital of a multi-specialty in-patient medical center in the period of 2021–2022 years.METHODS. The retrospective elective study analyzed data from 95 patients (95 eyes) with different stages of primary open-angle glaucoma (mean age 73 [67; 80] years old) who were hospitalized for surgical treatment of the disease in 2021–2022. In addition to standard ophthalmological examination, several clinical and epidemiologic characteristics were analyzed in detail, including the prevalence of prescriptions for antiglaucoma hypotensive drugs. Comparison of the obtained results with the data of similar procedures performed in the period from 2005 to 2016 was carried out.RESULTS. The number of main comorbid somatic diseases was on average 3 (2; 4), and comparison of conditions by disease stage revealed no significant differences (p&gt;0.05). Mean duration of the disease (according to anamnesis) was 8 (4; 13) years and was longer in comparison with similar results from 2005–2006 presented in a previous study. The period preceding the first surgical intervention was 5 (2; 10) years and was statistically significantly longer in those with moderate stage of POAG (9 [3; 14] years) compared to those with early stage of POAG (4 [3; 5] years, p&lt;0.05) and advanced stage of POAG (6 [0; 10] years, p&lt;0.04). The average number of drugs at the time of hospitalization for surgical treatment has increased significantly in comparison with the data of the early-mid 2000s and amounted to 4 (3; 4) units (stage I glaucoma — 3 [3; 4]; stage II — 4 [3; 4]; stage III — 4 [3; 4] units), with no statistically significant difference (p1,2=0.64; p1,3=0.21; p2,3=0.42, respectively).CONCLUSION. Unwarranted long-term use of a large number of antiglaucoma drugs ("maximal medication therapy adherence") is a significant problem in modern glaucomatology and can evidently affect future prognosis of the disease.

Comparative analysis of optical coherent angiotomography in patients with primary open-angle glaucoma

Objective: to conduct a comparative analysis of the parameters of the optic nerve head, retinal ganglion cells and microcirculation parameters in patients with primary open-angle glaucoma (POAG) of various stages in achieving the target intraocular pressure using the method of optical coherence angiotomography. Material and methods. 87 patients (87 eyes) with POAG were examined. Group 1 — 26 patients (26 eyes) with stage I POAG, group 2 — 19 patients (19 eyes) with stage II glaucoma, group 3 — 24 patients (24 eyes) with stage III glaucoma. Group 4 (control group) — 18 patients (36 eyes) without signs of glaucoma. Optical coherence tomography was performed on patients, angio-OCT scans 6.4x6.4 of the macula and optic nerve head were used. Results. The thickness of the nerve fiber layer (RNFL) was 94.00±10.54 urn in patients with stage I POAG, 48.00±1.00 urn and 41.00±1.73 urn in patients with stage II and III POAG, respectively, moreover, a more sensitive indicator is the RNFL in the lower peri-papillary zone (Inf RNFL). The thickness of the layer of retinal ganglion cells (RGCs) in patients with stage I POAG was 96.33±4.62 urn, with II — 70.33±1.53 urn, with III — 64.33±11.93 urn. The density of blood vessels in the area of the optic disc differed from the norm in patients with stages II and III of POAG (42.23±4.95 and 35.10±1.80, respectively). Conclusion. In patients with different stages of POAG, the greatest differences were found in RNFL in the lower segment, the area of the neuroretinal rim, the values of focal and global GCS loss, and the density of the vascular bed in the lower half of the peripapillary zone.

Эффективность циклофотокоагуляции в микроимпульсном режиме у пациентов с развитой и далеко зашедшей стадией первичной открытоугольной глаукомы

Purpose. To evaluate clinical efficacy and safety of micropulse cyclophotocoagulation (MP-CPC) in treatment patients with advanced and severe stages of primary open-angle glaucoma (POAG). Material and methods. Clinical study was carried out in 74 patients (74 eyes) with POAG aged 49 to 82 years. The advanced stage of glaucoma was detected in 35 eyes, the severe stage - in 39 eyes. The intraocular pressure (IOP) level before surgery varied from 23 to 36 mm Hg, averaging 29,6 ± 2,5 mm Hg. All patients underwent MP-CPC to standard technique using the Cyclo G6 Glaucoma Laser System the MicroPulse P3 glaucoma device (IRIDEX, USA). The observation period was 6 months. Results. All surgeries went without complications. The average IOP level on the 1st day after surgery was 21,1 ± 1,3 mm Hg. On the 1st day after surgery the more pronounced IOP decrease was revealed in patients with a dark (brown) iris color in comparison with a light (blue) iris. It was found that in periods to 6 months, the hypotensive effect of the surgery was more pronounced in patients of the age group under 60 years in comparison with the age group over 71 years. During the 1 year follow-up period, the IOP level was within normal values in 64 eyes (87%), averaging 20.9±1.2 mm Hg. Conclusion. MP-CPC is effective and safe operation to normalize IOP in most patients with advanced and severe stage of POAG with a follow-up period of 1 year. Keywords: micropulse cyclophotocoagulation, primary open-angle glaucoma, mild stage, moderate stage, intraocular pressure

Prospective assessment of cytokines and regulatory proteins concentration in the tear fluid of POAG patients with various hypotensive effects after non-penetrating deep sclerectomy

The aim. To assess the dynamics of cytokine content in tear fluid of primary openangle glaucoma (POAG) patients at various terms after non-penetrating deep sclerectomy (NPDS) in relation to the functional state of the outflow tracts.Material and methods. We carried out prospective examination of 65 patients with advanced stage of primary open-angle glaucoma after NPDS. Depending on the course of the postoperative period and the conditions for achieving the hypotensive effect of NPDS, all patients were divided into three groups: group 1 – with the optimal hypotensive effect; group 2 – with the conditional hypotensive effect; group 3 – with no hypotensive effect after NPDS. The intraocular pressure and the concentration of TGF-β, MMP-9, IL-6, IL-8, VEGF-A (121 and 165) in the tear fluid were studied using ELISA method in pre- and postoperative period. We studied the outflow tracts using optical coherence tomography and carried out ultrastructural analysis of filtering blebs tissue.Results. In group 1, the minimum initial concentrations of IL-6, IL-8 and TGF-β in the tear fluid and their moderate increase in the postoperative period; high concentrations of MMP-9 at all stages and an increase in VEGF-A by 2 months after NPDS were registered. In group 2, there was a high level of VEGF-A in the tear fluid before and 2 months after NPDS, an increase in TGF-β, IL-6 and IL-8 in the tear fluid in the early period with their suppression in the late period, as well as an increase in MMP-9 in the early postoperative period. Group 3 had maximum concentrations of TGF-β and IL-8 in the tear fluid initially and in the early postoperative period, suppression of MMP-9 in the tear fluid 2 weeks after and of VEGF-A 2 months after NPDS.Conclusion. Initially high concentrations of IL-6, IL-8, and TGF-β in the tear fluid and the suppression of MMP-9 and VEGF-A in the postoperative period contribute to the surgical failure of the NPDS.

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.