Various Forms Of Glaucoma Research Articles

Investigating the uncertain causal link between gut microbiota and glaucoma: A genetic correlation and Mendelian randomisation study.

Glaucoma is the most common cause of irreversible blindness, and gut microbiota (GM) is associated with glaucoma. Whether this association represents a causal role remains unknown. This study aims to assess the potential association and causal link between GM and various forms of glaucoma, emphasising the need for cautious interpretation of the strength of these associations. Employing a two-sample bidirectional Mendelian randomisation (MR) framework with false discovery rate correction and various sensitivity analyses, supplemented by genetic correlation analysis via linkage disequilibrium score regression (LDSC) and colocalisation for European summary-level data between MiBioGen consortium and FinnGen Study, we sought to explore the relationship between GM and glaucoma. While certain microbial taxa showed potential associations with glaucoma subtypes (e.g., Erysipelotrichaceae with primary angle closure glaucoma, Senegalimassilia with exfoliation glaucoma), the overall findings suggest a complex and not definitively causal relationship between GM and glaucoma. Notably, reverse MR analysis did not establish a significant causal effect of glaucoma on GM composition, and no consistent genetic correlations were observed between GM and glaucoma. While our study provides some evidence of associations between specific GM taxa and glaucoma, the results underscore the complexity of these relationships and the need for further research to clarify the potential causal links. The findings highlight the importance of interpreting the gut-eye axis with caution and suggest that while GM may play a role in glaucoma, it is unlikely to be a predominant causal factor.

Review of the risks of developing postoperative complications that might arise due to the treatment of various forms of glaucoma in dogs using transscleral cyclophotocoagulation

Transscleral cyclophotocoagulation is a promising method for treating various forms of glaucoma in dogs due to the possible adaptation of the total laser exposure protocol to each clinical case individually to achieve a hypotensive effect with a minimal probability of developing severe complications, so the issue of developing an optimal protocol is relevant. The research for the selection of such a protocol was carried out at the Department of Veterinary Surgery of the Federal State Budgetary Educational Institution of Higher Education MSAVM&B - MVA named after K. I. Scriabin and at the VC CEVO&M. To perform transscleral cyclophotocoagulation, a laser video endoscopic ophthalmological system Endo Optiks E2 was used, which contains a compact diode laser with a wavelength of 810 nm. In the process of selecting the protocol, based on the effectiveness of the exposure, the animals were divided into three groups: with insufficient (n=6), optimal (n=21) and excessive (n=3) total exposure. Changes in condition, including the development of complications, were assessed on the 1st, 7th and 30th days after surgery. In this study, a persistent hypotensive effect was achieved in dogs with primary open-angle glaucoma (POAG) in 90% of cases, in dogs with primary angle-closure glaucoma (PACG) in 66.7% of cases, in dogs with secondary angle-closure glaucoma (SCAG) in 58. 82% of cases. The study demonstrates the effectiveness of the proposed laser power protocol for the treatment of various forms of glaucoma in dogs. The best results were achieved in dogs in the group using the optimal protocol (n=21). The complications they developed were not severe and were amenable to therapeutic correction.

Совершенствование транссклеральной циклофотокоагуляции для лечения собак с разными формами глаукомы

Treatment of glaucoma in dogs with conservative methods does not always achieve a sufficient hypotensive effect, so the issue of surgical intervention is relevant. Due to the high risk of complications after invasive surgery, the use of transscleral cyclophotocoagulation (TCPC) is advisable. The article discusses the principle of selecting a protocol for laser exposure to the eye in the treatment of various forms of glaucoma in dogs. The work was carried out at the Department of Veterinary Surgery of the Federal State Budgetary Educational Institution of Higher Education MGAVMiB – MBA named after K. I. Skryabin and at the VC CEVO&M. To perform TCPC, the Endo Optiks E2 video endoscopic laser ophthalmological system was used, which contains a 175 W xenon light source, a compact diode laser with a wavelength of 810 nm, a power of 2,0 W and the ability to operate in pulsed and continuous modes, and a probe for TCPC. Depending on the form of glaucoma and the degree of increase in intraocular pressure, the total power of laser exposure to the eye varied. The results were assessed on the 1st day after surgery, on the 7th and on the 30th using a developed scoring system that takes into account the degree of reduction in intraocular pressure, changes in pupillary reflexes and clinical symptoms. The study found that in dogs with different forms of glaucoma and different initial intraocular pressure, the required hypotensive effect was achieved with different powers of the total impact of laser radiation on the eye. This protocol makes it possible to achieve a stable hypotensive effect in dogs with primary open-angle glaucoma (POAG) in 90 % of cases, in dogs with primary angle-closure glaucoma (PACG) in 66,7 % of cases, in dogs with secondary angle-closure glaucoma (SACG) in 58,82 % of cases. The study demonstrates the effectiveness of the proposed laser power protocol for the treatment of various forms of glaucoma in dogs. The best results were achieved in dogs with POAG (n=10). For dogs with angle-closure glaucoma, TCPC, as the only treatment method, does not achieve a stable hypotensive effect in the short-term and long-term period. In the case of PACG and SACG, it is necessary to use combined methods to reduce the production of intraocular fluid (TCPC) and to normalize the function of the drainage system of the eye.

Association of GNB3, ACE polymorphisms with POAG and NTG

ABSTRACT Purpose Primary open-angle glaucoma (POAG) represents the most prevalent form of glaucoma and stands as a foremost contributor to irreversible vision impairment on a global scale. Despite notable strides made in comprehending the genetic underpinnings of POAG, investigations within the context of Russia remain constrained. Methods The study cohort comprised a total of 235 individuals, with 135 of them exhibiting various forms of glaucoma encompassing both POAG and (NTG, while the remaining 100 individuals served as control subjects. Each participant underwent a comprehensive ocular examination to ascertain their ocular health status. Genotyping of the relevant single nucleotide polymorphisms (SNPs) was carried out using the Taq Man genotyping assay. Specifically, the two SNPs under scrutiny were GNB3 rs5443 gene and ACE rs4646994. Statistical analysis was performed to evaluate the association of these SNPs with glaucoma risk. Results The presence of the T allele of rs5443 was found to be associated with NTG (p = .004). However, no statistically significant correlation was identified between this SNP and POAG (p = .88). Conclusion This study provides evidence of an association between the T allele of rs5443 and a reduced susceptibility NTG within the Russian population. These observations augment the comprehension of the genetic underpinnings of glaucoma and hold potential implications for the prospective development of targeted therapeutic interventions.

Ab-interno Trabeculotomy Procedures: A Review.

To discuss the safety and efficacy of various forms of ab-interno trabeculotomy procedures. A comprehensive search in PubMed and Google Scholar was done using the keywords "glaucoma", "microinvasive glaucoma surgery", "complications", "goniotomy", and "trabeculotomy". Publications discussing ab-interno trabeculotomy procedures were selected; furthermore, the relevant references in these articles were gathered and the search was updated during the article preparation. Since gonioscopy-assisted transluminal trabeculotomy was first introduced in 2014, we had no time restriction. Ab-interno trabeculotomy procedures, as a type of minimally invasive glaucoma surgeries, facilitate the natural trabecular outflow and lower the intraocular pressure (IOP) while preserving the conjunctiva for possible future glaucoma surgeries. It can be done alone or in combination with cataract surgery and effectively lowers the IOP and the number of antiglaucoma medications in various forms of glaucoma. By appropriate patient selection, ab-interno trabeculotomy could be selected as a safe and effective procedure in the management of various forms of glaucoma either as an isolated procedure or in combination with cataract extraction.

Experience and efficiency of outreach diagnostics for glaucoma patients in Komsomolsk-on-Amur

The efficiency of outreach diagnostics was assessed in 273 patients suffering from various forms glaucoma aged from 27 to 80 years. Following the developed algorithm, a set of instrumental and diagnostic tests was carried out to select 153 patients for surgical treatment and 64 patients for laser treatment. Necessary adjustments were made to the regimens of antihypertensive treatment for most patients, and recommendations were given. All glaucoma patients selected for surgical and laser treatment received timely and qualified assistance from specialists of the Khabarovsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, which allowed the course of the disease to be stabilized and visual functions to be preserved. As a result, outreach consultations for patients with various forms of glaucoma showed their high efficiency. More than 60% of the examined patients were referred for surgical and laser treatment, 20% of patients were offered a corrected hypotensive regimen. Along with examining patients, outreach consultations provide methodological assistance for local ophthalmologists concerning the development of professional competencies in managing such patients. Due to a lack of ophthalmological services in regional polyclinical departments, the organization of outreach consultations for glaucoma patients is justified in terms of reducing cases of glaucoma progression and loss of visual functions.

Trace elements composition of the scleral shell of the eye in various forms of glaucoma

Purpose: a comparative study of the elemental composition of scleral biopsy specimens from patients with various clinical forms of glaucoma. Material and methods. 44 patients aged 79.5 ± 2.5 were divided into three groups depending on the form of glaucoma: 16 patients with primary open-angle glaucoma (POAG) (group 1); 13 patients with normal tension glaucoma (NTG) (group 2); 15 patients with pseudoexfoliative glaucoma (PEG) (group 3). For elemental analysis, we used scleral biopsies obtained during planned surgical treatment of glaucoma (non-penetrating sinus trabeculectomy). Scleral fragments of 14 donor eyes with no history of glaucoma served as controls. The concentration of macroelements K, Mg, Ca, and Fe was determined using inductively coupled plasma atomic emission spectrometry (ICP-AES, Agilent ICP-AES 720 ES, USA), while microelement concentration (Zn, Cu, Al, Mn) was measured using inductively coupled plasma mass spectrometry (ICP-MS, Bruker ICP-M S 820, Germany). Results. In all forms of glaucoma, scleral samples showed a varying increase in the content of such elements as Zn, Fe, Mg, AL, Ca, K. The highest content of Zn and Fe was found in the scleral tissue of patients with NTG, the difference with the control (p = 0.0001 andp = 0.0003) and with POAG (p = 0.0002, p = 0.0001) being highly significant. The difference between the content of Zn in scleral biopsies of patients with POAG and PEG was also statistically significant (p = 0.0002), whilst no significant difference in Fe content in the sclera (p = 0.69) was found between POAG and PEG Higher Mg concentrations as compared to the control were found in NTG (p = 0.00014) and POAG (p = 0.00002).Patients with POAG (p = 0.0005) and PEG (p = 0.00022) showed the highest accumulation of Ca in the sclera. No differences were found in Mg content of scleral biopsies between patients with NTG and POAG (p = 1.0), while the level of Ca in POAG (p = 0.02) and PEG (p = 0.00001) was significantly higher than in NTG. A significantly lower content of Cu was found in the sclera samples of patients with NTG (p = 0.022), POAG (p = 0.004) and PEG (p = 0.00004) as compared to the control, as well as a reduced content of Mn in POAG (p = 0.00003) and PEG (p = 0.0012). Contrarywise, NTG patients showed an increased content of Mn (p = 0.000003). No differences were found in the Cu content between the sclera of patients with NTG and POAG (p = 0.47), while Cu level in PEG was significantly lower than in POAG (p = 0.034) and NTG (p = 0.013). Conclusion. The macro- and microelement imbalance of the sclera of the eyes with different forms of glaucoma indicates differences in their pathogenesis. This can be the reason for the different severity of disorders of collagen biosynthesis and the formation of cross-links in the connective tissue structures of the sclera, as well as the varying degree changes in the hydrodynamics of the intraocular fluid, which on the whole can affect the level of intraocular pressure and the pattern of glaucoma development.

Modern Strategies for Using Selective Laser Trabeculoplasty in Treatment of Glaucoma. Review

This review analyzes the data on the effectiveness of the use effectiveness of the use of laser methods for the treatment of patients with glaucoma, namely selective laser trabeculoplasty. The authors analyzed the sources of domestic and foreign literature for 1996–2020. The review reflects the history of application of this method, as well as the rationale for choosing it, as the treatment for various forms of glaucoma. The efficiency of once or repeatedly applied procedures, depending also on the modification of SLT used, are presented according different authors. So far, SLT has been proven to be the laser treatment that improves the safety and efficacy of glaucoma treatment. It is necessary to continue research to study the possibilities of using it as an alternative to local hypotensive therapy, when choosing a treatment strategy for newly diagnosed initial glaucoma.

Imbalance of macro- and microelements in the scleral shell of the eye in various forms of glaucoma

PURPOSE. To conduct a comparative study of the balance of macro- and microelements in scleral biopsy samples taken from patients with various clinical forms of glaucoma.METHODS. The content of macro- and microelements was analyzed in scleral biopsy samples of 16 patients with primary open-angle glaucoma (POAG), 13 patients with normal tension glaucoma (NTG) and 15 patients with pseudoexfoliative glaucoma (PEG). The mean age of the patients was 79.5±2.5 years. For control, fragments of the sclera of 14 cadaveric eyes without a history of glaucoma were used. Concentration of macroelements — K, Mg, Ca, Fe — was determined by inductively coupled plasma atomic emission spectrometry, the level of microelements — Zn, Cu, Al, Mn — by inductively coupled plasma mass spectrometry.RESULTS. A statistically significant shift in the balance of Cu/Zn compared with controls was found in all forms of glaucoma: NTG (p=0.008), PEG (p=0.006), POAG (p=0.03); while no differences between NTG and POAG in this indicator were detected (p=0.609), with PEG the difference was significant (p=0.0001). The Cu/Fe ratio in the scleral samples of glaucomatous eyes also significantly differed from controls in both NTG (p=0.009) and PEG (p=0.006), as well as in POAG (p=0.006). This parameter in patients with POAG significantly differed from the corresponding parameter in the groups with NTG (p=0.0001) and PEG (p=0.016). A shift in the balance of Mn/Cu compared with controls was detected only in the sclera of patients with NTG (p=0.0064), there were no corresponding differences with controls in PEG (p=0.157) and POAG (p=0.773), but a significant difference was found between NTG and POAG groups (p=0.0001). The balance of Mn/Fe in comparison with the control group was disturbed in all forms of glaucoma: NTG (p=0.0066), PEG (p=0.00034), POAG (p=0.0027). At the same time, in patients with NTG and PEG, the balance of Mn/Fe differed significantly from this indicator in POAG (p=0.078 and p=0.0485, respectively). The most pronounced imbalance of Mg/Ca compared with controls was found in the sclera of patients with PEG (p=0.01) and POAG (p=0.0254).CONCLUSION. In all studied forms of glaucoma, disturbances in the ratios of Cu/Zn, Cu/Fe, Mn/Cu, Mn/Fe and Mg/Ca of varying severity in the sclera were revealed in comparison with the sclera of eyes without glaucoma. Differences in the indicated ratios between NTG, POAG and PEG have also been established, which may define the features in the pathogenesis and clinical course of these forms of glaucomatous lesions.

The genetics of glaucoma: Disease associations, personalised risk assessment and therapeutic opportunities-A review.

Glaucoma refers to a heterogenous group of disorders characterised by progressive loss of retinal ganglion cells and associated visual field loss. Both early-onset and adult-onset forms of the disease have a strong genetic component. Here, we summarise the known genetic associations for various forms of glaucoma and the possible functional roles for these genes in disease pathogenesis. We also discuss efforts to translate genetic knowledge into clinical practice, including gene-based tests for disease diagnosis and risk-stratification as well as gene-based therapies.

Again about carbonic anhydrase inhibitors: modern aspects of the use of ICA in ophthalmology

For more than 70 years, the inhibitors of carbonic anhydrase (ICA) have been used in the treatment of glaucoma. Since 1995, topical forms of ICA have appeared among antiglaucoma drugs — dorzolamide, and since 1999 — brinzolamide. The hypotensive efficacy and safety of topical ICA gave rise to the widespread use of these drugs in the treatment of various forms of glaucoma. The peculiarities of the mechanism of action made it possible to create on their basis effective fixed combinations, which allow reducing the intraocular pressure by up to 40 % in patients with glaucoma. The attractiveness of the drug has expanded due to the effect of ICA on various tissues of the organ of vision. Thus, ICAs effectively improve the hemodynamics of the eye and optic nerve. The antioxidant activity of the drug makes it possible to expand the indications for its use in patients with vascular patho-logy of the retina and optic nerve. The biomechanical characte-ristics of the drug allowed its effective and safe use in the complex treatment of macular edema of various etiologies. The adjuvant use of topical ICAs expands the possibilities of anti-VEGF therapy in the treatment of macular edema of various etiologies. Features of the action of ICA on the endothelial pump function of the cornea made it possible to formulate the rules for the use of topical ICA in patients with an insufficient function of the corneal endothelium.

Glaucoma and biomechanics.

Biomechanics is an important aspect of the complex family of diseases known as the glaucomas. Here, we review recent studies of biomechanics in glaucoma. Several tissues have direct and/or indirect biomechanical roles in various forms of glaucoma, including the trabecular meshwork, cornea, peripapillary sclera, optic nerve head/sheath, and iris. Multiple mechanosensory mechanisms and signaling pathways continue to be identified in both the trabecular meshwork and optic nerve head. Further, the recent literature describes a variety of approaches for investigating the role of tissue biomechanics as a risk factor for glaucoma, including pathological stiffening of the trabecular meshwork, peripapillary scleral structural changes, and remodeling of the optic nerve head. Finally, there have been advances in incorporating biomechanical information in glaucoma prognoses, including corneal biomechanical parameters and iridial mechanical properties in angle-closure glaucoma. Biomechanics remains an active aspect of glaucoma research, with activity in both basic science and clinical translation. However, the role of biomechanics in glaucoma remains incompletely understood. Therefore, further studies are indicated to identify novel therapeutic approaches that leverage biomechanics. Importantly, clinical translation of appropriate assays of tissue biomechanical properties in glaucoma is also needed.

Comparative analysis of intraocular pressure dynamics after phacoemulsification with intraocular lens implantation in eyes with primary glaucoma

PURPOSE. To conduct a comparative analysis of changes in intraocular pressure (IOP) after cataract phacoemulsification with implantation of intraocular lens (IOL) in comorbidity with primary open-angle (POAG) and primary closed-angle glaucoma (PACG).METHODS. The study analyzed the dynamics of IOP changes after cataract phacoemulsification in 65 patients (89 eyes) with comorbid PACG and 46 patients (58 eyes) with comorbid POAG, aged 50 to 92 years. Thirty-five (53.85%) patients with POAG had history of glaucoma surgery, and 12 (20.69%) patients with PACG had been treated with laser iridectomy. The disease was in the initial stage in 14.6% of POAG patients and 5.15% of PACG patients; moderate stage — in 55.05% and 47.19%, respectively; advanced stage — in 30.34% and 24.14%. Intraocular pressure in POAG was compensated in 84.5% and subcompensated in 15.5% of patients; in PACG it was compensated in 77.6%, subcompensated in 12.6%, and uncompensated in 10.4% of patients. Compensation of IOP was achieved either by previous surgeries, or application of local antihypertensive medications. Patients with subcompensated and elevated IOP received the maximum possible amount of hypotensive medications. The follow-up period ranged from 1 month to 2 years.RESULTS. Patients were divided into three groups according to postoperative IOP levels: the first group with IOP equal to preoperative level, the second group — with IOP below the initial level, and the third group with IOP above the initial level. The IOP levels were consistent with preoperative values at all follow-up periods in most of study patients, and after 2 years their portion exceeded 70%, while in POAG it was somewhat higher than in PACG (77.42% against 71.43%). The IOP below the preoperative level was observed in eyes with initial and moderate open-angle and closed-angle glaucoma, with the amount decreasing with longer follow-up (from 63.16% at 3 months to 16.13% after 2 years in POAG, and from 62.74% to 19.04% in PACG). In the early postoperative period, number of POAG and PACG patients in this group was comparable, but after 8 months it included more PACG patients. Elevation of IOP in both forms of glaucoma was most often observed in faradvanced stage in the early post-op period after phacoemulsification, subsequently their number decreased and by two years it decreased by almost twice (6.45% vs. 11.84% in POAG and 9.53% vs. 15.69% in PACG). During the entire follow-up period, the number of patients with ophthalmic hypertension in PACG was 30% higher than in POAG.CONCLUSION. The study showed that in most cases phacoemulsification has a stabilizing effect in patients with cataracts in combination with glaucoma. The hypotensive effect of the operation was observed in initial and advanced stages of glaucoma, when the drainage system of the eye was still preserved, and in the long term it was observed in a larger percentage of cases in angle-closure glaucoma compared to open-angle glaucoma. An increase in intraocular pressure relative to the preoperative level was observed in advanced glaucoma throughout the entire follow-up period, and the number of patients with angleclosure glaucoma was one-third higher than the number of patients with open-angle glaucoma. The obtained ambiguous results of intraocular pressure measurements after phacoemulsification of cataract with implantation of IOL in combination with various forms of glaucoma dictate the need for further study of this problem.

Novel approaches to glaucoma treatment (review of patents)

One of the priority directions in the development of medical science is activities associated with patenting and licensing. The review analyzes the inventions of new treatment methods of various forms of glaucoma among patents issued in the last 7 years. The search for new approaches to treating the disease continues despite the numerous known methods. The article describes promising medical, laser, microinvasive, surgical and combined methods for the treatment of glaucoma from the 123 new patents issued in the Russian Federation. Novel innovations are presented with design schemes.The review will be useful to a wide audience. Young specialists can invent, patent, and license their own original method of glaucoma treatment. Surgeons can expand their routine by introducing new technical elements from different methods, testing its effectiveness and safety in everyday practice.

Применение дренажной системы Ahmed в хирургическом лечении глаукомы детского возраста

Purpose – to evaluate the effectiveness of surgical treatment of glaucoma in children with implantation of the Ahmed Glaucoma Valve drainage system, depending on the form of the disease. Materials and methods. 124 implantations of the Ahmed Glaucoma Valve FP8 drainage system, model FP8, were performed in the Kaluga branch of the IRTC «Eye Microsurgery» for children with various forms of glaucoma for the period of time from 2010 to 2020. The range of children age was from 0 to 18 years old. Primary implantation was performed in 48 cases. 76 implantations were performed after previous glaucoma interventions. 23 patients were operated on in both eyes. The operation was performed with organ-preserving purpose for 26 patients at different ages. Implantation was performed for the eyes with low visual capabilities (below 0.06) in 34 cases. Results. It was noted to decrease in the level of IOP in various types of glaucoma in children in the early postoperative period, in 100% of cases. The level of IOP remained within the normal range in 68% of cases in terms of up to 1 year. The reasons of the increase in the level of ophthalmotonus were associated with the formation of a fibrous capsule above the drainage body and a disturbance in the flow of intraocular fluid in 32% of cases. An increase of IOP was noted up to 3 years in fifty per cent of cases. IOP was regulated by the appointment of antihypertensive medicine in the eyes, where the increase of IOP was not accompanied by significant visual signs of the formation of a fibrous filter pad. Otherwise, the inspection zone of the filtration pad was conducted an audit with excision of the fibrous tissue forming above the drainage body area. As a result, the level of IOP has reached normal values. Conclusion. Along with traditional treatment methods, operations using the Ahmed drainage system are promising in the treatment of childhood glaucoma. In case of some types of congenital glaucoma, they may be the operations of the first choice (in the associated and all secondary types of glaucoma). Undoubtedly, this type of surgery requires further improvements. Including the development of materials to cover the drainage system, which will interfere with severe scarring processes.

ANALYSIS OF SELECTIVE LASER TRABECULOPLASTY EFFECTIVENESS

Purpose of the study was to investigate the effectiveness of selective laser trabeculoplasty (SLT) in various forms of glaucoma, in the initial, advanced and far-advanced stages of the disease. Material and methods . An analysis of the effectiveness of the treatment of 132 eyes (132 patients), who were examined and treated in the department of glaucoma diagnostics and treatment of Ekaterinburg Center of Eye Microsurgery Federal State Institution, has been performed from 2016 to 2018. The study included a group of patients with primary open-angle, pseudoexfoliation, pigment, and combined forms of glaucoma previously not operated. Laser iridotomy was previously performed in patients with pigmented and combined glaucoma. The efficacy of SLT was assessed by the level of intraocular pressure (IOP) before SLT, after three days, 1, 6 and 12 months, using the perimetric MD index and according to the need for repeated surgical interventions during the observation period. Results. By the end of the observation period after SLT in patients with initial glaucoma IOP decreased by 5.1 mm Hg (by 20.7 %), with advanced glaucoma – by 6.3 mm Hg (by 25.7 %), with far-advanced glaucoma – by 6.8 mm Hg (by 31 %) compared to baseline values. Analysis of SLT effectiveness depending on the form of the disease showed that 12 months after surgery IOP in patients with primary open-angle glaucoma decreased by 5.5 ± 1.32 mm Hg (23 %) compared with baseline figures, and in patients with combined glaucoma – by 5.5 ± 1, 5 mm Hg (22.8 %). In the follow-up period from 6 to 12 months after SLT, 88 % of patients with pseudoexfoliation glaucoma, 64 % of patients with pigmentary glaucoma and 34 % of patients with combined glaucoma underwent non-penetrating deep sclerectomy, 15 % of patients with primary open-angle glaucoma underwent repeated SLT. Conclusion. SLT is the safe and effective method of glaucoma treating. In all forms and stages of glaucoma, target IOP was obtained, as evidenced by stabilization of retinal sensitivity by automated perimetry, but the hypotensive effect after SLT in patients with pseudoexfoliation glaucoma and pigmentary glaucoma lasted less than 1 year.

Glaucomatous optic neuropathy treatment options: the promise of novel therapeutics, techniques and tools to help preserve vision.

Peripheral vision loss followed by “tunnel vision” and eventual irreversible blindness is the fate of patients afflicted by various forms of glaucoma including primary open-angle glaucoma (POAG) and normotensive glaucoma (NTG). These complex and heterogeneous diseases are characterized by extensive death of retinal ganglion cells (RGCs) accompanied by retraction and severance of their axonal connections to the brain and thus damage to and thinning of the optic nerve. Since patients suffering from this glaucomatous optic neuropathy (GON) first notice visual impairment when they have lost > 40% of their RGCs, early diagnosis is the key to retard the progression of glaucoma. Elevated intraocular pressure (IOP), low cerebrospinal and/or low intracranial fluid pressure, advancing age, and ethnicity are major risk factors associated with POAG. However, retinal vascular abnormalities and a high sensitivity of RGCs and optic nerve head components to neurotoxic, inflammatory, oxidative and mechanical insults also contribute to vision loss in POAG/GON. Current treatment modalities for POAG and NTG involve lowering IOP using topical ocular drugs, combination drug products, and surgical interventions. Two recently approved multi-pharmacophoric drugs (e.g., rho kinase inhibitor, Netarsudil; a drug conjugate, Latanoprostene Bunod) and novel aqueous humor drainage devices (iStent and CyPass) are also gaining acceptance for treating POAG/ NTG. Neuroprotective and regenerative agents, coupled with electroceutical, mechanical support systems, stem cell transplantation and gene therapy are emerging therapeutics on the horizon to help combat GON. The latter techniques and approaches hope to rejuvenate RGCs and repair the optic nerve structures, thereby providing a gain of function of the visual system for the glaucoma patients.

Pathogenetic aspects of the drug in the treatment of glaucoma Cortexin optic neuropathy

Glaucoma is one of the first places among the causes of blindness and visual disability in the world. Currently, glaucoma is not treated as an isolated ocular pathology as well as a manifestation of the general exchange violations and neurovascular disorders in the body. The article presents the etiology and pathogenesis of glaucomatous optic neuropathy. Microcirculatory disorders observed in the form of a narrowing of the arteries and reduce the resulting perfusion pressure, the development of capillary stasis and rheological disorders (increased aggregation of red blood cells, reducing their ability to deformation). All this subsequently leads to local metabolic disorders. It is also an important role in the pathological chain may be joining vasospasm. The results of Cortexin use in various forms of glaucoma in both monotherapy and in treatment. Cortexin use in various forms of glaucoma as a monotherapy and in treatment. Cortexin peptide bioregulators, which reduces neuronal apoptosis, provides a neuroprotective and neurotrophic effects.

A Possible Role for LTBP2 in the Etiology of Primary Angle Closure Glaucoma.

Purpose:To assess the association of LTBP2 mutations with primary angle closure glaucoma (PACG).Methods:We studied 54 unrelated patients with PACG and one individual with pseudoexfoliation accompanied with angle closure glaucoma; these consisted of 28 female and 27 male subjects aged 27 to 82 (mean, 63) years. The 36 exons and flanking intronic sequences of LTBP2 in all patients were amplified by PCR and sequenced by the Sanger protocol. The sequences were compared to LTBP2 reference sequences. A total of 100 to 400 controls aged at least 60 years old were screened for various variations.Results:Out of 24 observed sequence variations, ten were in amino acid coding regions; of these four created synonymous codons while six caused amino acid changes. Based on allele frequencies, biochemical parameters, absence in control individuals, evolutionary conservation of affected amino acids, and bioinformatic predictions on the effects on protein function, it was concluded that only two mutations causing p. Gln1417Arg and p. Gly1660Trp may contribute to PACG. The p. Gly1660Trp mutation was observed in a patient with both PACG and PEX syndrome. P. Gln1417Arg had previously been reported only in a subject with POAG.Conclusion:LTBP2 may contribute to PACG. This finding emphasizes that there may be an overlap in the etiology of various forms of glaucoma and the overlaps likely contribute to common features in various forms of glaucoma.

Twenty-four hour efficacy of glaucoma medications.

Current medical therapy of glaucoma aims to attain a meaningful and consistent reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which will commensurate with either stability, or delayed progression of visual loss. Glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous. Therefore, it is reasonable that we should endeavor to identify the true efficacy of currently available and future antiglaucoma medications throughout the 24-h period. This review chapter deals first with the concept and value of diurnal and 24-h pressure monitoring. It then evaluates existing evidence on the 24-h efficacy of medical therapy options. Unfortunately, significant gaps exist in our present understanding of the short-term and particularly the long-term 24-h efficacy of most antiglaucoma medications. More long-term controlled evidence is needed in the future to improve our understanding of the 24-h efficacy of current medical glaucoma therapy, the ideal 24-h target pressure and the precise impact of IOP characteristics upon the different stages of the various forms of glaucoma.