scholarly journals The study of the efficiency of micropulse transscleral cyclophotocoagulation in the combined treatment of patients with secondary neovascular glaucoma

2021 ◽  
Vol 12 (4) ◽  
pp. 44-50
Author(s):  
Alla V. Sidorova ◽  
Anna V. Starostina ◽  
Mariia A. Pecherskaia ◽  
Margarita R. Khabazova ◽  
Alexey A. Arisov
Keyword(s):  
Combined Treatment ◽  
Pain Syndrome ◽  
Neovascular Glaucoma ◽  
Laser Coagulation ◽  
Post Surgery ◽  
Anti Vegf ◽  
Fast Development ◽  
Hypotensive Therapy ◽  
Transscleral Cyclophotocoagulation ◽  
High Level

Background: Neovascular glaucoma (NVG) is a highly refractory form, it is characterized by fast development and a high level of the intraocular pressure (IOP). Aims: To evaluate the effectiveness of micropulse transscleral cyclophotocoagulation (mCPC) in the combined treatment of patients with secondary neovascular glaucoma. Methods: The study included 32 patients (32 eyes) with secondary NVG as an outcome of diabetes mellitus and (or) thrombosis of the central retinal vein or its branches. The preoperative IOP averaged 38.88.8 mm Hg with the most intense hypotensive therapy. All the patients underwent mCPC. In the postoperative period, the patients were examined on the first day after the operation, then in 1 week, 1, 3, 6 months, 1 year after the operation. Results: All the operations were performed without complications. Pain syndrome in all cases was stopped on the first day after surgery. Six patients had reactive hypertension on the first day, therefore, the hypotensive therapy was intensified. The IOP 1 week after mCPC was 20.97.9 mm Hg, after 1 month of observation 23.76.0 mm Hg with the hypotensive therapy. 34 weeks post-surgery, six patients with the preserved visual function experienced a repeated IOP increase, and the Ahmed valve was implanted. 6 months after mCPC, the IOP level averaged 22.87.7 mm Hg with the hypotensive therapy. Against the background of the IOP compensation, anti-VEGF drugs were injected in 4 cases, followed by laser coagulation of the retina. Conclusion: Application of mCPC in NVG glaucoma patients showed only a small number of postoperative complications. This method of laser treatment can be used in combination with panretinal laser coagulation before or after the surgery, including administration of anti-VEGF drugs before or after the surgery. In case of the IOP increase, mCPC may be repeated.

Сombined (anti-VEGF and laser) treatment for operated secondary refractory neovascular glaucoma

2021 ◽  
pp. 24-26
Author(s):  
A.A. Gamidov ◽  
◽  
Z.V. Surnina ◽  
I.V. Andreeva ◽  
I.A. Velieva ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Antihypertensive Drugs ◽  
Optimal Algorithm ◽  
Sequential Therapy ◽  
Neovascular Glaucoma ◽  
Hypotensive Effect ◽  
Laser Coagulation ◽  
Anti Vegf ◽  
Secondary Refractory

Purpose. To develop an optimal algorithm for the management of patients with operated neovascular uncompensated glaucoma. Material and methods. 2 patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Ranibizumab (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed. Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up. Conclusion. The use of combined laser technologies and anti-VEGF therapy makes it possible to potentiate and prolong the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma. Key words: operated neovascular glaucoma, anti-VEGF, combined laser treatment.

scholarly journals Management of patients with operated refractory neovascular glaucoma (clinical observation)

2021 ◽  
pp. 374-378
Author(s):  
A. A. Gamidov ◽  
Z. V. Surnina ◽  
I. V. Andreeva
Keyword(s):  
Optic Nerve ◽  
Antihypertensive Drugs ◽  
Optimal Algorithm ◽  
Venous Blood ◽  
Neovascular Glaucoma ◽  
Laser Coagulation ◽  
Venous Blood Flow ◽  
Anti Vegf ◽  
Vascular Growth Factor ◽  
Central Retinal Vein

Introduction. Thrombosis (occlusion) of the central retinal vein (RCVO) and its branches is one of the main causes of loss or significant decrease in vision, including in people of working age, while RCVO is the second most common retinal vascular disease after diabetic retinopathy. The incidence rates steadily increase with age, amounting to 0.7% in the 49–60 age group and reaching 4.6% in people over 80 years old. Acute violation of retinal venous blood flow often leads to retinal ischemia, triggering the mechanism of activation of endothelial vascular growth factor (VEGF). In a quarter of patients, occlusions of the retinal veins and its branches initially proceed according to the ischemic type, which is characterized by the formation of extensive non-perfused retinal zones occupying an area of 10 or more areas of the optic nerve head (optic nerve disc) according to fluorescent angiography (FAG). In 34% of such patients, the non-ischemic type of venous occlusion becomes ischemic within 3 years.Aim. To develop an optimal algorithm for  the  management of  patients with operated neovascular uncompensated glaucoma against the background of occlusion of the central retinal vein.Materials and methods. Two patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Aflibercept (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed.Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up.Conclusion. The use of combined laser technologies and anti-VEGF therapy allows potentiating and prolonging the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma against the background of occlusion of the central retinal vein. 

scholarly journals Combined treatment of post-thrombotic neovascular glaucoma (clinical case study)

2021 ◽  
Vol 20 (3) ◽  
pp. 41-48
Author(s):  
A. V. Starostina ◽  
A. V. Sidorova ◽  
O. B. Klepinina ◽  
K. S. Norman ◽  
E. A. Smirnova ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Angiogenesis Inhibitor ◽  
Neovascular Glaucoma ◽  
Laser Coagulation ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Clinical Case Study ◽  
Ahmed Valve ◽  
Anterior Eye Segment ◽  
Central Retinal Vein

PURPOSE. To present the features of the clinical course and evaluate the effectiveness of laser and surgical treatment of patients with neovascular glaucoma following central retinal vein thrombosis.MATERIALS AND METHODS. Two patients with neovascular glaucoma secondary to central retinal vein thrombosis were examined. Surgical interventions were performed: patient M. — micropulse cyclophotocoagulation (twice), intravitreal administration of an angiogenesis inhibitor (5 injections), retinal laser coagulation (two-stage); patient E. — micropulse cyclophotocoagulation, intravitreal administration of an angiogenesis inhibitor (2 injections), implantation of the Ahmed valve.RESULTS. The treatment resulted in compensation of intraocular pressure (IOP), improvement of visual functions, reduction of neovascularization in the structures of the anterior eye segment.CONCLUSION. Micropulse cyclophotocoagulation can be used in the complex treatment of neovascular glaucoma at any stage in order to reduce IOP and decrease the neovascularization in the iris and anterior chamber angle structures in the postoperative period.

Micropulse Transscleral Cyclophotocoagulation in the Combine Treatment of Neovascular Glaucoma

GlaucomaNews ◽  
2020 ◽  
pp. 71-75
Author(s):  
N.S. Khodzhaev ◽  
◽  
A.V. Sidorova ◽  
M.A. Eliseeva ◽  
◽  
...  
Keyword(s):  
Laser System ◽  
Combined Treatment ◽  
Neovascular Glaucoma ◽  
Ultrasound Biomicroscopy ◽  
Vascular Growth ◽  
Vegf Inhibitor ◽  
Anti Vegf ◽  
Surgical Methods ◽  
Treatment Procedures

Introduction. Neovascular glaucoma (NVG) is one of the most prognostically unfavorable forms of the glaucomatous process. The leading pathogenetic mechanism for the development of NVH is hypoxia of the inner layers of the retina, leading to the development of endothelial vascular growth factors (VEGF), which induce neovascular proliferation. In the presence of newly formed vessels in the corner of the anterior chamber, the use of traditional surgical methods for treating glaucoma is limited. That is why the search for a new pathogenetically oriented methods for the treatment of NVH is still acute issue in ophthalmology. Purpose. To evaluate the preliminary results of combined treatment, including intraocular introduction of anti-VEGF therapies (ranibizumab) and micropulse cyclophotocoagulation, in patients with secondary neovascular glaucoma. Materials and methods. The study included 15 patients (15 eyes) with secondary neovascular glaucoma. The value of intraocular pressure (IOP) before surgery ranged from 28 to 44 mm Hg. (average 36.3 ± 4.4 mm Hg), the number of hypotensive drops was 3.5 ± 0.5. The combine treat of patients including the intraocular administration of a VEGF inhibitor (ranibizumab) and through 7-14 days transscleral diode-laser cyclophotocoagulation in micropulse mode on the device «Cyclo G6 Glaucoma Laser System» (IRIDEX, USA) with a laser power of 2000 mW, an exposition of 160 s (80 s in each hemisphere) and a duty cycle of 31.3%. Results. All treatment procedures were performed without complications. By 6 months of follow-up, the average IOP level was 26.9 ± 3.3 mm Hg, the number of hypotensive drops was reduced to 2.7 ± 0.7 drugs. By 1 month of observation, a decrease in the number of newly formed vessels of the iris was achived in all patients. According to ultrasound biomicroscopy, the thickness of the ciliary body (CT) before treatment was on average 0.58 ± 0.14 mm. By 6 months of follow-up, no cases of postoperative atrophy of CT was diagnosed, the thickness of the CT was on average 0.53 ± 0.11 mm. According to the data of optical coherence tomography in the angiography mode, in all cases there was a positive dynamic in 1 month after combined treatment - a significant decrease in macular edema, the area of the retinal nonperfusion zone and the number of newly formed vessels. Conclusion. Combined treatment of patients with secondary neovascular glaucoma, including intraocular introduction of anti-VEGF therapies and micropulse cyclophotocoagulation, is an effective and safe method for reducing IOP.

scholarly journals Treatment outcomes of central retinopathy of prematurity with localization in the Moscow regional perinatal center

2021 ◽  
Vol 16 (3) ◽  
pp. 19-26
Author(s):  
A. Y. Panova ◽  
A. S. Petrova ◽  
S. A. Trusova ◽  
O. A. Shevernaya
Keyword(s):  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Promising Result ◽  
Antiangiogenic Therapy ◽  
Combined Treatment ◽  
Posterior Pole ◽  
Laser Coagulation ◽  
Vegf Inhibitor ◽  
Anti Vegf ◽  
Perinatal Center

BACKGROUND: Ranibizumab is widely used in retinopathy of prematurity. Therefore, it is necessary to evaluate the effectiveness, the risk of complications, and recurrence of the disease by antiangiogenic therapy. AIM: To demonstrate the experience of using anti-VEGF drugs in the Moscow Regional Perinatal Center and the effectiveness of different approaches to retinopathy of prematurity (ROP) treatment in the central retinal zone. MATERIAL AND METHODS: The case histories of 17 deeply premature infants with threshold ROP stages and localization in the posterior pole were retrospectively analyzed. Children were treated with intravitreal VEGF inhibitor (total 9 children), 5 children underwent laser coagulation of the retina, and 3 children received combined treatment (laser and intravitreal administration of a VEGF inhibitor). RESULTS: The average age of development of threshold stages was 35.2 weeks (range: 30.539 weeks) in our study. The frequency of promising outcomes after using anti-VEGF drugs alone or in conjunction with peripheral laser treatment was 100%. In comparison, the only laser treatment generated a promising result in 70% of the eyes. However, ROP relapses after anti-VEGF therapy developed at 37, 43, 44,5 weeks. In addition, 1 out of 9 children developed a recurrence of ROP and required laser treatment 7 weeks after using anti-VEGF. CONCLUSION: The use of anti-VEGF therapy is an effective method for the treatment of ROP of the posterior pole. However, there is the ambiguity of the available recommendations on the further management of children. Therefore, it is necessary to monitor the children who have received antiangiogenic therapy for as long as possible.

scholarly journals Photodynamic Therapy Combined with Antibiotics or Antifungals against Microorganisms That Cause Skin and Soft Tissue Infections: A Planktonic and Biofilm Approach to Overcome Resistances

2021 ◽  
Vol 14 (7) ◽  
pp. 603
Author(s):  
Vanesa Pérez-Laguna ◽  
Isabel García-Luque ◽  
Sofía Ballesta ◽  
Antonio Rezusta ◽  
Yolanda Gilaberte
Keyword(s):  
Photodynamic Therapy ◽  
Soft Tissues ◽  
Combined Treatment ◽  
Resistance Pattern ◽  
Antimicrobial Photodynamic Therapy ◽  
Antimicrobial Drugs ◽  
Bacteria And Fungi ◽  
High Level ◽  
Selection Of

The present review covers combination approaches of antimicrobial photodynamic therapy (aPDT) plus antibiotics or antifungals to attack bacteria and fungi in vitro (both planktonic and biofilm forms) focused on those microorganisms that cause infections in skin and soft tissues. The combination can prevent failure in the fight against these microorganisms: antimicrobial drugs can increase the susceptibility of microorganisms to aPDT and prevent the possibility of regrowth of those that were not inactivated during the irradiation; meanwhile, aPDT is effective regardless of the resistance pattern of the strain and their use does not contribute to the selection of antimicrobial resistance. Additive or synergistic antimicrobial effects in vitro are evaluated and the best combinations are presented. The use of combined treatment of aPDT with antimicrobials could help overcome the difficulty of fighting high level of resistance microorganisms and, as it is a multi-target approach, it could make the selection of resistant microorganisms more difficult.

Mirror-image sensory dysfunction in the post-thoracotomy pain syndrome

2012 ◽  
Vol 3 (3) ◽  
pp. 193-193
Author(s):  
Mads U. Werner ◽  
Thomas K. Ringsted ◽  
Henrik Kehlet ◽  
Kim Wildgaard
Keyword(s):  
Primary Outcome ◽  
Lung Neoplasm ◽  
Pain Syndrome ◽  
Mirror Image ◽  
Major Surgery ◽  
Mechanical Stimuli ◽  
Test Procedures ◽  
Sensory Dysfunction ◽  
Post Surgery ◽  
Sensory Mapping

Abstract Background/aims Mirror-image sensory dysfunction (MISD) has been described in various medical conditions, but has not been systematically characterized following major surgery. Methods The presence of MISD was evaluated with standardized thermal and mechanical stimuli, in a group of preoperative patients scheduled for thoracotomy (n = 14) and in patients with post-thoracotomy pain syndrome (PTPS = 14). The primary outcome was areas with sensory dysfunction evaluated by dynamic sensory mapping with metal-rollers and a brush. The test procedures were repeated after 2 weeks in PTPS-patients. Results The preoperative patients all had normal sensory mapping. In all PTPS-patients sensory dysfunction on the surgical side was observed, while in 12/14 patients MISD was demonstrated. In 5/12 patients, the spatial distribution of MISD areas corresponded to the sensory dysfunction on the surgical side. The total areas of sensory dysfunction (median, [25–75% interquartile range]) were Day 1, on the surgical side 500 cm2 (289–636) and on the non-surgical side 60cm2 (0–379 [P<0.005]), and on Day 2, 355cm2 (266–697) and 81 cm2 (0–202379 [P< 0.0002]), respectively. Area of sensory dysfunction on the surgical side, respectively on the non- surgical side, did not differ significantly between Day 1 and Day 2 (P >0.5). Conclusions Mirror-image sensory dysfunction is a prevalent finding in PTPS-patients. The sensory dysfunction does not seem related to the underlying lung neoplasm per se. The study demonstrated a high day-to-day variability both in sensory dysfunction areas in the surgical side and in MISD-areas. The pathophysiological mechanisms behind MISD in chronic post-surgery pain deserve further study.

Results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema

2021 ◽  
pp. 17-21
Author(s):  
L.N. Boriskina ◽  
◽  
A.S. Zotov ◽  
A.S. Balalin ◽  
S.V. Balalin ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Macular Edema ◽  
Neovascular Glaucoma ◽  
Proliferative Retinopathy ◽  
Iol Implantation ◽  
Second Stage ◽  
Corrected Visual Acuity ◽  
Complicated Cataract ◽  
Diabetic Proliferative Retinopathy ◽  
Transscleral Cyclophotocoagulation

Objective. To evaluate the results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema. Material and methods. A retrospective study of the complicated cataract surgery with IOL implantation results was performed in 38 patients (38 eyes) with neovascular glaucoma. The first stage was Lucentis intravitreal injection, then after 2 weeks intraocular pressure (IOP) under combined medical therapy was determined: 1) if IOP was <25 mm Hg, then phacoemulsification was performed; 2) if IOP remained >25 mm Hg, the second stage was transscleral cyclophotocoagulation, and 2 weeks later – cataract phacoemulsification. Results. All patients with neovascular glaucoma had significant increase of the best corrected visual acuity from the initial level on the 1st day, 1- and 3-months post-op. IOP values under medical treatment corresponded to the range of the average statistical norm. There was no recurrence of neovascularization or IOP increase. Conclusion. The application of Lucentis intravitreal injections as well as IOP lowering to the average statistical norm range under medication or laser surgery provide the basis for an effective and safe complicated cataract surgery with IOL implantation in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or post-thrombotic macular edema. Key words: cataract, neovascular glaucoma, phacoemulsification.

Evaluation of complications of the late postoperative period in patients with diabetes mellitus after drainage surgery of neovascular glaucoma

2021 ◽  
pp. 10-12
Author(s):  
V.A. Biletskaya ◽  
◽  
D.V. Lipatov ◽  
M.A. Frolov ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Postoperative Period ◽  
Pain Syndrome ◽  
Neovascular Glaucoma ◽  
Research Centre ◽  
Federal State ◽  
Key Words Diabetes Mellitus ◽  
Key Words Diabetes ◽  
Surgical Methods

Today diabetes mellitus (DM) is one of the leading medical and social problems. Its complications lead to terrible concomitant pathologies that qualitatively affect the lives of patients. At the end of 2019, there were more than 463 million people with diabetes in the world and this number is increasing every year. Diabetic retinopathy (DR) is one of the most severe complications of DM on the organ of vision. Secondary neovascular glaucoma (NG) is a manifestation of the end-stage proliferative DR. This is a relatively rare but difficult-to-treat pathology that often leads working-age patients to disability and impaired social adaptation. The main objective of treatment for NG is to compensate for intraocular pressure (IOP), but conservative (drug) therapy is often ineffective. Therefore, doctors are forced to use surgical methods of treatment. At the same time, do not forget about the multiple complications during the operation, as well as in the early and late postoperative periods. A special feature of the course of NG in patients with DM is its combination with the failure of the ligamentous-capsular apparatus of the lens, iris bombage, anterior and posterior synechiae, traction retinal detachment and various hemorrhagic complications. All this allows us to talk about the so-called diabetic glaucoma (DG). Currently, drainage devices have become the standard in the treatment of refractory NG. The effectiveness of such operations according to various sources is about 70-80% of success. Purpose. To assess the condition of patients with DM in the late (10-15 years) postoperative period after performing NG drainage surgery, to analyze the effectiveness of the intervention by studying the dynamics of IOP, the presence or absence of pain syndrome and various intraocular complications. Material and methods. During the period 2006-2020, 150 patients with NG and DM were operated on in the Department of Diabetic Retinopathy of the Federal State Budgetary Institution «Endocrinology Research Centre» of the Ministry of Health of the Russian Federation. Results. In 100% of the postoperative period, the pain syndrome was stopped. And also, in 59.7% of cases, the presence of late complications: vascular thorn, EED, subatrophy and anophthalmos. Conclusion. Despite the presence of complications, drainage surgery in patients with DM continues to be an effective method of choosing surgical treatment for patients with uncompensated NG. Key words: diabetes mellitus; diabetic retinopathy; neovascular glaucoma; drainage surgery.

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