Clinical efficacy of osteopathic correction in the complex treatment of patients with unoperated open-angle glaucoma

Author(s):  
E. N. Simakova ◽  
O. V. Stenkova

Introduction. Glaucoma is one of the most significant eye diseases. It is often diagnosed, not always amenable to therapy, and can lead to a complete loss of visual functions. In recent years, the method of osteopathic correction has become widespread as one of the effective methods of treatment and rehabilitation of patients with pathologies of various body systems. In the pathogenesis of glaucoma, it is customary to distinguish a dystrophic concept, which considers primary open-angle glaucoma as a result of dystrophic changes in the connective tissue, as well as in the endothelial lining of the trabeculae and Schlemm′s canal, especially destructive changes in mitochondria and the alteration of their functional activity. A vascular concept is also distinguished. According to this concept, the central link in the pathogenesis of glaucoma is circulatory disorder in the ciliary vessels, ocular artery, and major vessels of the head and neck, it can be assumed that osteopathic correction in the treatment of patients with open-angle glaucoma will be pathogenetically substantiated and will have a positive effect on intraocular pressure and trophicity of the optic nerve. The goal of research — to study the influence of in osteopathic correction on the nature of unoperated glaucoma (stage IIA) and to substantiate the possibility of using osteopathic correction in the complex treatment of patients with this pathology.Materials and methods. A prospective controlled randomized study was conducted at 52 city polyclinics, branch 3, Moscow, from January 2018 to January 2019. 40 patients (70 eyes) aged 50 to 75 years with primary open-angle glaucoma IIA stage were examined. At this stage of the disease, patients most often seek medical care and the issue of conservative management is primarily considered. All patients were divided into two groups of 20 people: the main group and the control group. The treatment in the main group included hypotensive drug therapy and osteopathic correction. Patients of the control group received only drug therapy. All patients underwent ophthalmic (visometry, tonometry, perimetry) and osteopathic examination twice: before the treatment and after 3 months.Results. For patients with primary open-angle IIA non-operated glaucoma, regional (most often regions of the head, neck, dura mater) and local (abdominal diaphragm, iliac bones, hip and knee joints) somatic dysfunctions were the most typical. In the main group a statistically significant decrease in the frequency and severity of dysfunctions at all levels was stated. Also, in patients receiving osteopathic correction, a significant decrease in the level of intraocular pressure and perimetric indices was noted. In patients of the control group, no reliable changes in these indicators were obtained.Conclusion. The results obtained indicate that osteopathic correction is clinically effective in the complex treatment of patients with primary open-angle II A glaucoma.

The Eye ◽  
2019 ◽  
Vol 125 (2019-1) ◽  
pp. 6-12
Author(s):  
Irina Gndoyan ◽  
Natalya Kuznetsova ◽  
Alexander Derevyanchenko

Purpose: To determine the role that progressive spectacle lenses play in intraocular pressure compensation and stabilization of the glaucomatous process in patients with primary open-angle glaucoma (POAG) combined with presbyopia and refractive errors. Material and methods. 29 patients (53 eyes) aged 43 to 67 years with I-II stage POAG and a certain type of refractive error were enrolled into study. All patients had intraocular pressure (IOP) compensated to the target level on medication. Patients of the main group (17 people, 32 eyes) used universal progressive spectacle lenses with optimized surface. The patients of the control group (12 people, 21 eyes) used separate monofocal glasses for near and distance vision as a method of ametropia correction. Visual acuity test, refractometry, pneumotonometry, tonography, automated static perimetry were applied for monitoring the patients. The measurements were taken before spectacle correction and a year after its prescription. Results. A decrease of IOP (p=0.01) and an increase of the aqueous humor outflow coefficient (p<0.01) were determined after one year use of the recommended type of vision correction in the main group, whereas in the control group there was an increased level of IOP (p<0.05) and a reduced aqueous humor outflow coefficient (p<0.2). Conclusion. The use of progressive spectacle lenses as a method of permanent vision correction reliably reduces IOP and improves the aqueous humor outflow in patients with early-stage POAG. The absence of negative visual field dynamics indicates the stabilization of the glaucomatous process.


Author(s):  
B.G. Dzhashi ◽  
◽  
T.N. Zhdanova ◽  
S.V. Balalin ◽  
A.R. Vinogradov ◽  
...  

Purpose. Analysis of the effectiveness of surgical treatment of patients with primary open-angle glaucoma associated with cataract the first stage realization of cataract phacoemulsification with IOL implantation (PHACO), and the second stage - microinvasive nonpenetrating deep sclerectomy (MNPDS). Material and methods. The results of 234 cases of performing PHACO and MNPDS at various stages have been analyzed. The main group included patients who underwent PHACO, followed by MNPDS – 39 persons, 40 eyes. The group was divided into a subgroup based on the date of the second intervention. 1 subgroup – patients who underwent MNPDS 1 month after PHACO (11 cases); 2 subgroup – 3 months after PHACO (29 cases). The control group included patients who underwent MNPDS followed by PHACO – 180 persons, 195 eyes. Also, subgroups of patients were identified for whom PHACO + IOL was performed in the second stage after 1 month – 1 subgroup (99 cases) and after 3 months – 2 subgroup (96 cases). Results. Patients of the main group showed a significant decrease in intraocular pressure after each stage of treatment. in the control group, intraocular pressure decreased after the first stage of treatment, but increased 6 months after surgery. Conclusions. According to the study, in primary open-angle glaucoma associated with cataract, the most persistent hypotensive effect is observed when the first stage of cataract phacoemulsification is performed, and the second stage is antiglaucoma surgical intervention. Key words: glaucoma, cataract, cataract phacoemulsification, microinvasive nonpenetrating deep sclerectomy.


2021 ◽  
pp. 66-76
Author(s):  
O. V. Zubkov ◽  
E. A. Smirnova ◽  
V. V. Kramar ◽  
O. I. Kurbatov

Introduction. Glaucoma is a chronic eye disease characterized by a constant or periodic increase in intraocular pressure, a decrease of visual fields and visual acuity, and by a special form of optic nerve atrophy with excavation in the disc area. The reflection of this slowly fl owing atrophy is a disturbance in the visual field and a complete irreversible loss of visual function. The prevalence of the disease increases with increasing age. The main methods of treatment are medical and surgical. Non-penetrating operations are recognized as the safest methods of surgical treatment of glaucoma. The most common complications of such operations include: detachment of the choroid, small anterior chamber syndrome, hyphema, cicatricial changes in the filtration cushion. Based on the analysis of literature data, it can be assumed that the inclusion of osteopathic correction in the complex therapy of patients with operated glaucoma can increase the effectiveness of therapy.The aim of the research was to study the clinical efficacy of osteopathic correction in the complex treatment of patients operated on primary open-angle glaucoma.Materials and methods. The study involved 20 patients (20 eyes) aged 70 to 75 years with developed and advanced stages of primary open-angle glaucoma, who underwent surgical treatment. The main (10 people) and control (10 people) groups were formed by simple randomization. Participants in the main group received standard medical therapy and osteopathic correction, while participants in the control group received only medical therapy. Changes in the following clinical parameters were evaluated: visual acuity, visual fi eld, intraocular pressure, thickness of the retinal nerve fiber layer, and severity of pain syndrome. Indicators were recorded at the beginning of the study (2 weeks after surgery) and at the end of the study (2–3 months after surgery).Results. Patients receiving osteopathic correction as part of the complex therapy after surgery of primary openangle glaucoma are characterized by a statistically significant (p<0,05) decrease in the severity of pain syndrome, an increase in the magnitude of the visual field and of the thickness of the retinal nerve fiber layer.Conclusion. The obtained results suggest the effectiveness of the inclusion of osteopathic correction in the complex treatment of patients with operated on primary open-angle glaucoma. It is recommended to continue the study with a larger sample size.


10.12737/5480 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 1-5
Author(s):  
Сурнин ◽  
S. Surnin ◽  
Захарова ◽  
Irina Zaharova ◽  
Приставка ◽  
...  

The authors studied the efficiency of the Neuromidin in complex treatment of the patients with primary open-angle glaucoma. 65 patients (130 eyes), of which 44 advanced stage, 76 - with severe and 10 eyes with a terminal stage of primary open-angle glaucoma (POAG) were examined. These patients received the Neuromidin in the dose of 1 ml (15 mg) intramuscularly, №10, with complete therapy (the Emoxipin in/m, the Piracetam in/in, the medication parabulbarno). Then, the patients received 1 tablet 2 times daily (20 mg) within 25 days as the monotherapy with local hypotensive drops (timolol, azopt, azarga, fotil, cosopt, alphagan P). Intraocular pressure compensation was achieved by timolol 0,5% dropping (45 eyes), azopt dropping (28 eyes), alphagan P dropping (6 eyes) and by means of combination drugs: azarga (32 eyes), cosopt (15 eyes) and fotil (4 eyes). Of them, in 52 eyes surgical treatment was made. The control group consisted of 30 patients (60 eyes), who received the treatment without the Neuromidin. In work the authors used the standard methods of ophthalmic research. The increase of visual acuity and expansion of field of view in both groups was revealed, but in the patients treated by means of the Neuromidin the visual acuity increased in advanced 0.13, in patients with severe degree of disease – in 0.12, in the control group – in 0.06 and 0,05, respectively . Field of view has expanded in an advanced stage of 55 degrees, and in severe – 35 degrees higher than in the control group. The Neuromidin effect on the state of the outflow of aqueous humor was revealed. This effect can be explained by the fact that the drug stimulates the impulse conduction in nerve fibers and synapses, blocks of cholinesterase, stimulates the ciliary muscle and activation of the outflow watery moisture. The achieved effect gradually decreases to the initial indicators within 6 months in 2/3 patients.


2022 ◽  
Author(s):  
Mitsuya Otsuka ◽  
Atsushi Hayashi ◽  
Naoki Tojo

Abstract Purpose: To compare surgical outcomes between Ex-PRESS® surgery (EXP) and trabeculectomy (Trab) for primary open angle glaucoma (POAG) with low preoperative intraocular pressure (IOP).Patients and Methods: This was a retrospective non-randomized study. We included POAG patients with preoperative IOP ≤16 mmHg who were taking tolerance glaucoma medications. We compared the surgical outcomes, postoperative IOP, number of glaucoma medications, reduction rate of corneal endothelial cell density (ECD), visual acuity, and postoperative complications between POAG patients who underwent EXP (34 eyes) or Trab (38 eyes) and could be followed for >2 years.Results: Both surgeries significantly decreased the IOP (p<0.001): at 2 years, EXP provided decreases from 13.4 ± 2.3 to 10.2 ± 3.1 mmHg, Trab provided decreases from 13.5 ± 2.0 to 8.9 ± 3.2 mmHg. No significant differences were observed in the postoperative IOP (p=0.076), number of postoperative medications (p=0.263), success rate (p=0.900), reduction rate of ECD (p=0.410), or difference in visual acuity (p=0.174). The reduction rate of IOP was significantly high in the Trab group (p=0.047).Conclusions: Both surgeries significantly decreased IOP and were useful surgical methods for low-IOP glaucoma. Our results suggest that trabeculectomy can decrease IOP more than Ex-PRESS surgery but might have more complications.


2019 ◽  
Vol 16 (1S) ◽  
pp. 91-95 ◽  
Author(s):  
I. I. Khusnitdinov ◽  
A. E. Babushkin

Purpose: comparative study of trabeculectomy results with various models of domestic “Glautex” drainage in the surgical treatment of primary open angle glaucoma (POAG). Patients and methods. The results of surgical treatment of 98 (105 eyes) patients with POAG aged 50–83 years who underwent trabeculectomy with various Glautex drainage models were analyzed. There were 43 men (43.9 %) and 55 (56.1 %) women. The second (II) stage of POAG was diagnosed in 49 eyes (46.7 %), the third (III) stage in 56 (53.3 %). All patients were divided into 3 groups. The first (main) group consisted of 34 (37 eyes) patients who underwent trabeculectomy in combination with the implantation of Glautex DDA drainage model. The second (main) group included 29 (30 eyes) patients with trabeculectomy and implantation of the SDA model of this drainage. The third group was the control group and consisted of 35 (38 eyes) patients with the classical method of surgery without using any drainage. Results. There was a significant 71.7 % decrease in IOP compared with baseline data in the 1st patients group after antiglaucomatous surgery, 72 and 74 % decrease was in the 2nd and 3rd groups respectively (p < 0.05). An increase in IOP was noted predominantly in the control and in the second study group within 1 month of follow-up. Normalization of ophthalmotonous pressure was achieved by using needling in 13.3 % (4/30) patients in the second group, in 7.9 % (6/38) cases in the control group. The absolute hypotensive effect in the 1st group was noted in 75.7 % of cases; the relative hypotensive effect was in 8.1 %; total failure was in 16.2 %. In the 2nd group the absolute hypotensive effect of the surgery was in 73.3 % of 30 cases, the relative was in 6.7 %, total failure was in 20 %. In the control group (38 eyes), absolute success was in 63.1 %, the relative hypotensive effect was in 13.2 %, and the total failure was in 23.7 %. Conclusion. Trabeculectomy with Glautex drainage and with various models in case of primary open-angle glaucoma provided a sufficiently high relative hypotensive effect in 82 % of cases in a year after the surgery. The achieved surgery outcomes with this drainage in the studied periods did not depend on applied model: DDA or SDA (83.8 and 80 % respectively), but was higher than the classical trabeculectomy (76.3 %). However, in case of the SDA model, needling was required in 13.3 % of cases in the early postoperative period. 


2021 ◽  
Author(s):  
Elshimaa A.Mateen ◽  
Hatem Gamal Ammar ◽  
Khulood Muhammad Sayed

Abstract Purpose: To evaluate specular microscopic changes of corneal endothelial cells (CEC) count and morphology in correlation to retinal nerve fiber layer RNFL changes detected by visual field (VF) and OCT in early and advanced primary open-angle glaucoma (POAG).Methods: A prospective observational comparative study was conducted on patients with POAG versus non-glaucomatous patients of the same age group. Specular microscopy, VF test, OCT scans of RNFL, and macular ganglion cell complex (GCC) were performed. Glaucoma group was further subdivided into early and advanced stages.Results: The study included 130 eyes of 130 subjects, 70 were eyes with POAG (glaucoma group), 60 were healthy eyes (control group). Both groups were comparable regarding mean age and sex.In the early glaucoma group, a significant negative correlation was found between the coefficient of variation (CV%) and superior PRNFL thickness (r=-0.5, p-value=0.018). A significant negative correlation was also found between percentage of cellular hexagonality (HEX%) and vertical cup/disc (C/D) ratio (r=-0.43, p-value= 0.035). A significant positive correlation was found between HEX% and (superior, inferior) PRNFL thickness (r=0.53, 0.5 and p-value= 0.008, 0.015) respectively.Mean CEC count was significantly lower in the advanced glaucoma group than in the control group (2958.7±371.2 vs 3085±172.5, p value=0.043). Conclusions: CEC is affected by chronic intraocular pressure (IOP) elevation just like the PRNFL and macular GCC. CEC morphology is insulted in the early stages of POAG while the count can withstand chronic IOP elevation till advanced stages were both are affected.


2019 ◽  
Vol 12 (4) ◽  
pp. 35-42
Author(s):  
T. N. Malishevskaya ◽  
D. G. Gubin ◽  
I. V. Nemcova ◽  
A. S. Vlasova ◽  
Ju. E. Filippova ◽  
...  

Purpose. To analyze the daily dynamics and the parameters of intraocular pressure circadian rhythm (IOP CR) in patients with primary open-angle glaucoma (POAG) (stable and progressive forms) and determine chronobiological regularities of glaucoma progression depending on the patterns of restructuring the daily dynamics of IOP CR and body temperature.Material and methods. The study included 75 POAG patients, of which 35 had a stable form (S-POAG) and 40 had a rapidly progressing form (P-POAG). The control group was composed of 80 subjects without POAG. The index of retinal ganglion cell loss measured by optical coherence tomography (OCT) was used as a criterion of POAG progression. IOP was measured by the patients themselves for 72 hours at 7 time points (3 am, 8 am, 11 am, 2 pm, 5 pm, 8 pm, and 11 pm, who used an Icare ONE portable intraocular pressure tonometer for individual use.Results. IOP daily dynamics was distributed differently in the different groups. In S-POAG, the peak values were mainly reached in the morning hours, while the minimum values were observed at night. In P-POAG, the peak values of IOP were contrariwise recorded at night. In both POAG groups, an increase of irregular fluctuation share was noted, which indicated a decrease of the CR contribution to the IOP CR. Moreover, in POAG, a change in the phase ratio between the IOP CR and CR of body temperature was observed. For IOP CR phase violation manifestations, the threshold value of GCS global loss index was determined at 10–15 % according to OCT data.Conclusion. IOP daily dynamics were shown to differ in S-POAG and P-POAG patients. In both groups. Signs of desynchronization were detected. The ganglion retinal cell global loss index can be used to determine phase disturbances of IOP CR.


2019 ◽  
Vol 72 (7-8) ◽  
pp. 202-208
Author(s):  
Bojana Markic ◽  
Milka Mavija ◽  
Sasa Smoljanovic-Skocic ◽  
Sanela-Sanja Burgic

Introduction. It has been recognized that cataract surgery leads to a reduction of intraocular pressure, both in healthy and in glaucoma patients. This prospective interventional clinical study aimed to investigate the effects of cataract surgery on intraocular pressure and its short- and long-term fluctuations in medically controlled primary open-angle glaucoma patients and non-glaucomatous patients. Material and Methods. Two groups of 31 patients (31 eyes) were studied. The observed group included patients with glaucoma and cataract, and the control group included patients with senile cataract only. The intraocular pressure was measured three times daily pre- and at 1, 3 and 6 months postoperatively. Results. In both groups, a significant postoperative reduction in both mean and maximum intraocular pressure. Six months after surgery, in the observed group the average and maximum intraocular pressure reduction levels were -2.73 ? 1.91 mmHg and -3.16 ? 2.19 mmHg, and -2.26 ? 1.71 mmHg and -2.53 ? 1.70 mmHg in the control group. In the observed group, at 3 and 6 months after surgery, a significant reduction in short-term fluctuations was observed. Six months after surgery, short-term fluctuations decreased by -1.04 ? 2.20 mmHg compared to preoperative. Postoperatively, in the observed group, long-term fluctuations of average and maximum intraocular pressure were 2.69 ? 2.15 mmHg and 2.88 ? 2.22 mmHg, respectively, and in the controls they were 2.02 ? 1.28 mmHg and 2.42 ? 1.47 mmHg, showing no significant differences between groups. Conclusion. In patients with primary open-angle glaucoma, cataract surgery results in a statistically significant reduction in both average and maximum intraocular pressure as well as of short-term fluctuations.


Author(s):  
Е.В. Собанчеев ◽  
Ю.А. Витковский ◽  
А.С. Емельянов ◽  
А.Н. Емельянова ◽  
Е.А. Жаринова ◽  
...  

Актуальность. Несмотря на всестороннее изучение патогенеза первичной открытоугольной глаукомы (ПОУГ), механизмы возникновения заболевания до конца не изучены. В настоящее время определена роль аквапоринов в регуляции внутриглазного давления. Были обнаружены мутации, усиливающие и снижающие функции аквапорина 4, описано влияние различных генетических вариантов аквапоринов на величину внутриглазного давления. Цель исследования. Исследовать частоту встречаемости вариантов полиморфизма rs2075575 (C/Т) гена аквапорина 4 у больных ПОУГ. Материалы и методы. В исследовании приняли участие 101 пациент с ПОУГ и 80 здоровых людей (контрольная группа). Возраст исследуемых колебался от 45 до 87 лет. Средний возраст составил 66 лет. Критерием включения в основную группу служил диагноз ПОУГ развитой, далеко зашедшей и терминальной стадий. Критериями включения в контрольную группу служили возраст старше 60 лет, отсутствие глаукомы и выраженной соматической патологии. ДНК выделяли из буккального эпителия. Полиморфизм гена аквапорина 4 rs2075575 определяли методом полимеразной цепной реакции. Результаты. Установлено, что распределение генотипов у пациентов с ПОУГ отличается от группы здоровых лиц. Обнаружено, что генотип СС среди больных глаукомой встречается в 1,8 раза чаще, чем в контрольной группе. Наоборот, генотип СТ выявляется в 1,5 раза чаще в контрольной группе. Отношение шансов (OR) для генотипа СС равно 2,48 (95% CI 1,30-4,74). У генотипа СТ выявляется протекторная роль, OR =0,52 (95% CI 0,28-0,97). Частота встречаемости генотипа ТТ в исследуемых группах не различается. Выводы. Полиморфный вариант rs2075575 (C/Т) гена аквапорина 4 вносит вклад в риск развития ПОУГ в исследованной выборке. Background. Despite a comprehensive study of the pathogenesis of the disease, the mechanisms of primary open-angle glaucoma are not completely clear. Currently, the role of aquaporins in the regulation of intraocular pressure has been determined. Mutations were discovered that enhance and decrease the functions of aquaporin 4. The effect of various genetic variants of aquaporins on the value of intraocular pressure is described. The aim of research. To investigate the variability of the polymorphism of aquaporin 4 rs2075575 (C / T) in patients with glaucoma. Materials and methods. 101 persons with primary open-angle glaucoma and 80 persons without glaucoma (the control group) were examined. The age of the subjects ranged from 45 to 87 years. The average age was 66 years. The criterion for inclusion in the main group was the diagnosis of primary open-angle glaucoma of a developed, distant and terminal stage. The criteria for inclusion in the control group were age over 60 years, the absence of glaucoma, the absence of pronounced somatic pathology. DNAs were extracted from buccal epithelium. The polymerase chain reaction (PCR) method was used to determine the polymorphism of the aquaporin gene 4 rs2075575. Results. There was a significant difference in the distribution of genotypes in the study and control groups. СС genotype among patients with glaucoma occurs 1.8 times more often than in the control group. CT genotype, on the contrary, is 1.5 times more often in the control group. The odds ratio (OR) for this genotype is 2.48 (95% CI 1.30 - 4.74). The CT genotype reveals a protective role, OR = 0.52 (95% CI 0.28 - 0.97). The genotype of TT in the studied groups is slightly different in frequency of occurrence. Conclusion. The frequencies of gene polymorphisms of aquaporin 4 rs2075575 (C/Т) in patients with primary open-angle glaucoma and healthy were diverse. The likelihood of developing primary open-angle glaucoma is increased in carriers of the СС genotype. Genotype CT play a protective role for primary open-angle glaucoma.


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