FEATURES OF GERIATRIC STATUS IN PATIENTS WITH CARDIOVASCULAR AND OPHTHALMOLOGICAL PATHOLOGY

2021 ◽  
pp. 33-38
Author(s):  
Александр Викторович Иванов ◽  
Татьяна Игоревна Субботина ◽  
Антон Александрович Титов ◽  
Юрий Юрьевич Блинков ◽  
Надежда Александровна Поздеева ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Geriatric Assessment ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Cognitive Status ◽  
Open Angle ◽  
Cardiovascular Pathology ◽  
Personal Anxiety

У пациентов пожилого возраста часто наблюдается сочетание полиморбидной сердечно-сосудистой патологии с офтальмопатологией и, в частности, с первичной открытоугольной глаукомой (ПОУГ). Однако гериатрический статус таких пациентов изучен недостаточно. Цель исследования: изучение особенностей гериатрического статуса пожилых больных с сочетанной сердечно-сосудистой и офтальмопатологической патологией. Обследовано в клинических условиях 58 пациентов с инфарктом миокарда, артериальной гипертензией и первичной открытоугольной глаукомой. Установлено, что развитие офтальмопатологии в виде первичной открытоугольной глаукомы в сочетании с сердечно-сосудистой патологий сопровождается формированием и прогрессированием гериатрического континуума пожилых пациентов. Уровень личностной тревожности при первичной гериатрической оценке у анализируемых больных составлял 42,9±1,1 балла и соответствовал умеренному уровню тревожности. Однако после хирургического лечения он незначительно понизился до 40,6±1,2 балла (Р±0,05). Аналогичные изменения характерны и для ситуативной тревожности, которая при первичной гериатрической оценке была умеренной (40,8±1,2 балла) и не претерпела существенных изменений после выполнения антиглаукомного хирургического вмешательства, составив 40,3±1,4 балла (Р±0,05). Оценка когнитивного статуса пациентов пожилого возраста с первичной открытоугольной глаукомой в до и после операционном периодах показывает недостоверное снижение когнитивного дефицита. Уровень когнитивных нарушений по шкале CFS у пациентов в предоперационном периоде составлял 18,22±0,4 балла (легкие когнитивные нарушения). Следовательно, полиморбидная патология изменяет гериатрический статус пациентов, что следует учитывать в гериатрической практике In elderly patients, a combination of polymorbid cardiovascular pathology with ophthalmopathology and, in particular, with primary open-angle glaucoma (POAG) is often observed. However, the geriatric status of such patients has not been sufficiently studied. Objective: to study the features of the geriatric status of elderly patients with combined cardiovascular and ophthalmopathological pathology. A total of 58 patients with myocardial infarction, arterial hypertension, and primary open-angle glaucoma were examined in clinical settings. It was established that the development of ophthalmopathology in the form of primary open-angle glaucoma in combination with cardiovascular pathology is accompanied by the formation and progression of the geriatric continuum of elderly patients. The level of personal anxiety in the primary geriatric assessment in the analyzed patients was 42.9±1.1 points and corresponded to a moderate level of anxiety. However, after surgical treatment, it decreased slightly to 40.6±1.2 points (P±0.05). Similar changes are also characteristic of situational anxiety, which was moderate (40.8±1.2 points) in the initial geriatric assessment and did not undergo significant changes after performing anti-glaucoma surgery, amounting to 40.3±1.4 points (P±0.05). Assessment of the cognitive status of elderly patients with primary open-angle glaucoma in the pre-and postoperative periods shows an unreliable decrease in cognitive deficits. The level of cognitive impairment on the CFS scale in patients in the preoperative period was 18.22±0.4 points (mild cognitive impairment). Consequently, polymorbid pathology changes the geriatric status of patients, which should be taken into account in geriatric practice

scholarly journals Neuroinflammation in Primary Open-Angle Glaucoma

2020 ◽  
Vol 9 (10) ◽  
pp. 3172 ◽  
Author(s):  
Stefania Vernazza ◽  
Sara Tirendi ◽  
Anna Maria Bassi ◽  
Carlo Enrico Traverso ◽  
Sergio Claudio Saccà
Keyword(s):  
Oxidative Stress ◽  
Immune Response ◽  
Trabecular Meshwork ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Antioxidant Defences ◽  
Age Related ◽  
Wide Range

Primary open-angle glaucoma (POAG) is the second leading cause of irreversible blindness worldwide. Increasing evidence suggests oxidative damage and immune response defects are key factors contributing to glaucoma onset. Indeed, both the failure of the trabecular meshwork tissue in the conventional outflow pathway and the neuroinflammation process, which drives the neurodegeneration, seem to be linked to the age-related over-production of free radicals (i.e., mitochondrial dysfunction) and to oxidative stress-linked immunostimulatory signaling. Several previous studies have described a wide range of oxidative stress-related makers which are found in glaucomatous patients, including low levels of antioxidant defences, dysfunction/activation of glial cells, the activation of the NF-κB pathway and the up-regulation of pro-inflammatory cytokines, and so on. However, the intraocular pressure is still currently the only risk factor modifiable by medication or glaucoma surgery. This present review aims to summarize the multiple cellular processes, which promote different risk factors in glaucoma including aging, oxidative stress, trabecular meshwork defects, glial activation response, neurodegenerative insults, and the altered regulation of immune response.

scholarly journals Ab externo implantation of the MicroShunt, a poly (styrene-block-isobutylene-block-styrene) surgical device for the treatment of primary open-angle glaucoma: a review

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Omar Sadruddin ◽  
Leonard Pinchuk ◽  
Raymund Angeles ◽  
Paul Palmberg
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Operative Management ◽  
Glaucoma Drainage Device ◽  
Outer Diameter ◽  
Open Angle ◽  
Less Invasive ◽  
Randomized Clinical Study ◽  
Suture Tension

AbstractTrabeculectomy remains the ‘gold standard’ intraocular pressure (IOP)-lowering procedure for moderate-to-severe glaucoma; however, this approach is associated with the need for substantial post-operative management. Micro-invasive glaucoma surgery (MIGS) procedures aim to reduce the need for intra- and post-operative management and provide a less invasive means of lowering IOP. Generally, MIGS procedures are associated with only modest reductions in IOP and are targeted at patients with mild-to-moderate glaucoma, highlighting an unmet need for a less invasive treatment of advanced and refractory glaucoma. The PRESERFLO® MicroShunt (formerly known as InnFocus MicroShunt) is an 8.5 mm-long (outer diameter 350 μm; internal lumen diameter 70 μm) glaucoma drainage device made from a highly biocompatible, bioinert material called poly (styrene-block-isobutylene-block-styrene), or SIBS. The lumen size is sufficiently small that at normal aqueous flow hypotony is avoided, but large enough to avoid being blocked by sloughed cells or pigment. The MicroShunt achieves the desired pressure range in the eye by draining aqueous humor from the anterior chamber to a bleb formed under the conjunctiva and Tenon’s capsule. The device is implanted ab externo with intraoperative Mitomycin C via a minimally invasive (relative to incisional surgery) surgical procedure, enabling precise control of placement without the need for gonioscopy, suture tension control, or suture lysis. The implantation procedure can be performed in combination with cataract surgery or as a standalone procedure. The MicroShunt received Conformité Européenne (CE) marking in 2012 and is intended for the reduction of IOP in eyes of patients with primary open-angle glaucoma in which IOP remains uncontrolled while on maximum tolerated medical therapy and/or in which glaucoma progression warrants surgery. Three clinical studies assessing the long-term safety and efficacy of the MicroShunt have been completed; a Phase 3 multicenter, randomized clinical study comparing the MicroShunt to primary trabeculectomy is underway. In preliminary studies, the MicroShunt effectively reduced IOP and use of glaucoma medications up to 3 years after implantation, with an acceptable safety profile. This article summarizes current literature on the unique properties of the MicroShunt, the preliminary efficacy and safety findings, and discusses its potential use as an alternative to trabeculectomy for glaucoma surgery.

scholarly journals Primary Outcomes of Combined Cataract Extraction Technique with Ab-interno Trabeculectomy  and Endoscopic Cyclophotocoagulation  in Patients with Primary Open Angle Glaucoma

2020 ◽  
Author(s):  
Juan Carlos Izquierdo ◽  
Josefina Mejias ◽  
Laura Cañola ◽  
Natalia Agudelo ◽  
Barbara Rubio
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Surgical Success ◽  
Corrected Visual Acuity ◽  
Ab Interno Trabeculectomy ◽  
The Mean ◽  
Best Corrected Visual Acuity ◽  
Ab Interno

Abstract Background: Glaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma. Methods: A retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. Inclusion criteria: 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP <14 mmHg either with no medications (complete success) or with medications (qualified success). Results: A total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0±3.7 mmHg and postoperatively was 11.6±1.9 mmHg and 11.4±1.8 mmHg (P<0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9±1.4 to 0.56±1.05 at 9 month follow-ups (P<0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months.Conclusions: In patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.

Comparison of Hypotensive Effect of Endotrabeculoectomy and Selective Laser Trabeculoplasty

2021 ◽  
pp. 19-25
Author(s):  
Olha V. Levytska ◽  
Igor Ya. Novytskyy
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Hypotensive Effect ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty ◽  
Significant Difference ◽  
The Difference

Hypotensive effect of endotrabeculectomy was compared with that of selective laser trabeculoplasty in patients with primary open-angle glaucoma (POAG). We evaluated 44 patients (44 eyes) with POAG. In the first group (23 patients), endotrabeculectomy (trabecular ablation through the angle of anterior chamber) was performed, and in the second group (21 patients) the patients underwent selective laser trabeculoplasty. When comparing the intraocular pressure (IOP), it was found that the difference between preoperative and postoperative IOP was significant up to 6 months of follow-up in both groups (p < 0.05), however, hypotensive effect in the first group was more pronounced (7.58 vs. 1.55 mmHg, respectively). When comparing the number of hypotensive medications used before and after glaucoma surgery, it was found that the difference in patients of the first group was significant throughout the observation period (p = 0.028), while in patients of the second group there was no significant difference from the 3rd month of observation. The number of topical drugs to reduce IOP decreased by 1.44 in the first group (p < 0.05) and by 0.33 in the second group (p = 0.109). Endotrabeculectomy, as well as selective laser trabeculoplasty, showed significant hypotensive effect in patients with POAG within 6 months of observation, however, hypotensive effect of endotrabeculectomy significantly overweighted that of SLT. Keywords: endotrabeculectomy, selective laser trabeculoplasty, intraocular pressure, primary open-angle glaucoma.

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