Drainage surgery for primary open-angle glaucoma: past, present, future

Relevance. Despite many techniques for reducing intraocular pressure, surgical treatment of glaucoma has limited effectiveness. First, due to excessive scarring of new intraocular fluid outflow pathways and second, antifibrotics medicaments are unable to effectively control wound healing. The use of drainages reduces the risk of excessive scarring in the area of the filtration pad and forms several ways of outflow of intraocular fluid. The review presents the following sections: development history, advantages, disadvantages, surgical technique and promising directions of glaucoma drainage surgery. Purpose. Summarizing data on the possibility of drainage surgery, historical aspects, causes of scarring and methods of dealing with them. Provide data on various modern drainage devices that are used not only in Russia and their effectiveness. Material and methods. To perform the review, we searched for literature sources on the abstract databases E-library, PubMed and Scopus for the period up to and including 2018, using the keywords «glaucoma drainage surgery» (in the E-library database), «anti-glaucoma drainage» and «anti-glaucoma drainage device» (in the PubMed and Scopus databases). Abstracts of conferences were excluded from the review. A total of 40 articles related to the review topic were identified. The beginning of publications on this issue in domestic sources dates back to 1970, and in foreign sources to 1987. Results. The review presents the history of development, advantages, disadvantages of surgical techniques and promising areas of glaucoma drainage surgery. Various models of drainage devices, as well as their specific and non-specific complications are described. The effectivenes of various valves were 70%, with an average decrease in the level of IOP by at least 50% from the preoperative values. At the same time, the risk of an increase in the level of IOP above the target values is about 10% per year, which leads to the fact that after 5 years only in 50% of cases drainage devices function effectively. Therefore, studies of biomaterials, forms and techniques of drainage implantation surgery, new controlled-release antifibrotic drugs can positively affect the long-term effectiveness of glaucoma surgery. Conclusion. The data presented in the literature review allow us to identify the most effective models of drainage devices, their effectiveness, implantation techniques and possible complications. Key words: glaucoma, refractory glaucoma, glaucoma drainage surgery, drainages.

Assessment of the impact of medPlan®, a medication reminder mobile application, in glaucoma patients in Benin City, Nigeria

Purpose: To assess the impact of medPlan®, a medication reminder mobile application in glaucoma patients in Benin City, Nigeria.Methods: In a randomized control trial with 2 months follow-up period, 200 patients receiving drug therapy for glaucoma were randomized into either into a control or study group. The study group comprised participants who made use of a medication reminder mobile application, medPlan®, while the control group consisted of those patients who did not use the application. Adherence to medication was measured for all the patients in both groups. Data was collected using a carefully designed questionnaire and statistically analyzed.Results: This study recorded 100 % response rate from the participants. In the study group, 56 % were very adherent while 18 % were moderately adherent, and 26 % were non-adherent respondents as against 45 % very adherent, 13 % moderately adherent and 42 % non-adherent respondents from the control group. In addition, 78 % of those in the study group agreed that there was improvement in their medication adherence since they started using the medication reminder application. This showed a significant positive impact of the medication reminder application (p = 0.0110) on adherence to medication.Conclusion: Medication adherence was improved in glaucoma patients who used medPlan®, a smartphone medication reminder application. This study lays a foundation for further research on medication reminder mobile applications. Keywords: Glaucoma, Smartphone, Medication adherence, Impact, Medication reminder, medPlan®

To assess the role of cataract extraction in glaucoma management by its intraocular pressure lowering effect

Objective: To measure the mean change of intraocular pressure (IOP) in glaucoma patients with cataract after uncomplicated phacoemulsification surgery with intraocular lens (IOL) implanted in capsular bag. Methods: A total of 40 patients who had uncomplicated cataract extraction by phacoemulsification with IOL implant in the capsular bag in glaucomatous eyes of age 30-80 years were included. Patients with corneal pathologies or had corneal refractive procedure, history of ocular trauma, uveitis, retinal pathologies or other ocular comorbids were excluded. Visual acuity, IOP, slit lamp examination, fundoscopy, visual fields, details about topical medication and relevant history was recorded not more than 5 days before cataract extraction. IOP was recorded (first individually, then average of all) by Goldman’s applanation tonometer one day before surgery, 1 month and 3 months post op. Results: Age range in this study was from 30 to 80 years with mean age of 52.23 ± 9.44 years. Majority of the patients i.e. 28 (70.0%) were between 30 to 55 years of age. Out of these 40 patients, 19 (47.50%) were male and 21 (52.50%) were females with male to female ratio of 1:1.1. Mean pre-operative IOP was 20.42 ± 1.69 mmHg, after 1 month of surgery was 18.55 ± 0.90 mmHg and after 3 months was 17.03 ± 1.19 mmHg (p-value = 0.0001). Conclusion: This study concluded that there is significant change of intraocular pressure in glaucoma patients with cataract after uncomplicated phacoemulsification surgery with IOL implanted in capsular bag. Keywords: Glaucoma, phacoemulsification, intraocular pressure Continuous...

A Study on Glaucoma Awareness and the Source of Health Information in a Rural Population of Tamil Nadu

BACKGROUND Glaucoma causes progressive loss of vision and significantly affects the quality of life. In 2019 World Health Organization reported that glaucoma caused blindness in 4.5 million people and is the second most common cause of blindness worldwide. In India, nearly 1.2 million people were blind due to glaucoma of whom 90 percent remain undiagnosed in the community. The aim of this study is to assess the level of glaucoma awareness and to analyse the source of information that created awareness in a rural community. METHODS A community based cross-sectional study was conducted in a village which is an outreach field practice area of our institution in Tamil Nadu, during the month of October 2019. The total study participants were 196 and data was collected by interview method and analysed using SPSS 16v software. RESULTS Among 196 respondents 12.2 % were aware of glaucoma, 85 % were aware that it leads to blindness, 38 % had heard about glaucoma from close acquaintances through word of mouth and 3 had undergone glaucoma evaluation in an outreach camp. CONCLUSIONS This study concludes that awareness of glaucoma among the rural population continues to be poor. Hospital based awareness activity and word of mouth were the major source of information in our study group. Patients with glaucoma had better knowledge and they would play an effective role in creating awareness. Our study shows that the social media and mass media awareness campaign did not reach the rural population. KEYWORDS Glaucoma Awareness, Health Information

Assessment of the Quality of Life of Glaucoma Patients In Kazakhstan (on the Example of Balkhash)

The purpose of the study: analysis and assessment of the quality of life of glaucoma patients in Kazakhstan on the example of Balkhash. Methods. The study was conducted on the basis of the municipal state institution (KSU) "Polyclinic No. 2" of the city of Balkhash, Karaganda region in the period from 2019 to 2020. The study involved 46 men and 74 women. The average age of the respondents was ≥64 years. To determine the quality of life of glaucoma patients, we conducted a questionnaire compiled by ourselves and the NEI VFQ-25 questionnaire. The respondents were conditionally divided into three groups: group 1-patients who receive only conservative treatment; group 2 – patients who underwent laser correction in parallel with conservative treatment; group 3-patients who, in addition to previous types of treatment, were operated on. Results. Among the comparison groups, the values of indicators of dependence on the help of others (23.7) and role difficulties (23.9) and social activity (81.6) were significantly lower in patients receiving only conservative treatment. In this group, along with the physical and mental components, it was found that the gap in visual indicators is up to 4 times. Conclusions. The results of the study show that in glaucoma patients receiving only conservative treatment, the quality of life is low compared to the control groups according to all indicators of the scales. A significant impact on the decrease in the quality of life of patients receiving conservative treatment is caused by the discomfort associated with regular use of drugs prescribed for glaucoma and their side effects. Keywords: glaucoma, quality of life, NEI VFQ-256 questionnaire, Kazakhstan.

Realization of a cascade treatment algorithm for glaucoma in St. Petersburg

Aim: to analyze the duration and regimen of topical treatment and the pattern of prior laser and surgical procedures in patients with glaucoma who were admitted to the hospital for IOP-lowering interventions. Patients and Methods: this study included 500 consecutively enrolled patients who underwent surgery for uncontrolled glaucoma in 2016– 2020 and were followed up for 6–24 months. Disease history, cumulative "preservative" load, clinical examinations, and surgical outcomes were assessed. Results: preoperatively, most patients received the maximum medical therapy (i.e., three agents in two bottles). Simultaneous use of all four major classes of IOP-lowering medications occurred in 10% of patients only. Two-third of patients required surgical interventions to reduce IOP after a 6-year medical therapy. By the time of admission, 60% of patients were diagnosed with advanced or end-stage glaucoma. Prior laser or surgical procedures to reduce IOP were performed only in 142 patients and 52 patients, respectively. Treatment adherence was lower in men compared to women, irrespective of its stage. Conclusion: most patients received adequate medical therapy. However, in general, surgery was performed too late. It gives the impression that the efficacy of therapeutic and laser stages of cascade glaucoma treatment is no more than five years. In addition to the obvious drawbacks of a laissez-faire strategy (irreversible vision loss), the risk of surgical failure significantly increases. Long-term (at least 3-year) therapy using (non)fixed-dose combinations of agents containing preservatives is the major modifiable risk factor for early filtration loss. Preservativefree prostaglandin analogues improve treatment tolerability, adherence to treatment, and chances for success of IOP-lowering surgery. The authors’ results demonstrate that gender differences should be considered when planning treatment and follow-up visits. Keywords: glaucoma, IOP-lowering therapy, glaucoma surgery, ocular surface, preservatives, benzalkonium chloride. For citation: Antonova A.V., Nikolaenko V.P., Brzheskiy V.V. Realization of a cascade treatment algorithm for glaucoma in St. Petersburg. Russian Journal of Clinical Ophthalmology. 2021;21(3):123–128 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-123-128.

Morphological and functional retinal changes in postoperative hypotony

Aim: to analyze the retinal microvascular network changes in hypotony maculopathy after non-penetrating deep sclerectomy (NPDS). Patients and Methods: the study enrolled 35 patients (35 eyes) with uncontrolled glaucoma stages II and III in whom the intraocular pressure (IOP) level was less than 10 mm Hg after NPDS. In addition to a standard eye exam, all patients underwent optical coherence tomography angiography (OCTA) before and one day after surgery. In addition, the radial peripapillary capillary (RPC) network vessel density (VD) on 4×4-mm optic nerve scans, superficial vascular plexus (SVP) VD on 6×6-mm macular scans, and foveal avascular zone (FAZ) area on 3×3-mm scans were evaluated. Results: IOP-lowering effect was reported in all patients, i.e., IOP level reduced by, on average, 17.7±8.3 mm Hg. In 15 patients, baseline OCTA parameters worsened (group 1). In 17 patients, OCTA parameters improved (group 2). In 3 patients, OCTA parameters remained unchanged (group 3). In group 1, parafoveal VD reduced by 1.5% [2.45%; 0.85%] in the superior sector and 1.3% [1.75%; 0.85%] in the inferior sector. Peripapillary VD reduced by 0.6% [2.0%; 0.1%] in the superior sector and 1.1% [2.4%; 0.0%] in the inferior sector. In group 2, parafoveal VD improved by 0.85% [0.0%; 1.75%] in the superior sector and 1.2% [0.68%; 2.6%] in the inferior sector. Peripapillary VD improved by 1.2% [0.18%; 2.0%] in the superior sector and 0.95% [0.05%; 1.75%] in the inferior sector. IOP levels were similar. No correlations between OCTA parameters and IOP levels were revealed. Postoperatively, the FAZ area remained unchanged. Conclusions: postoperative hypotonia has a positive and negative impact on the retinal microvascular network. OCTA findings after NPDS demonstrate no correlations with IOP levels. Further studies are needed to identify prognostic factors of hypotony maculopathy and assess its long-term effects on retinal vessels. Keywords: glaucoma, non-penetrating deep sclerectomy, hypotony maculopathy, OCTA. For citation: Erichev V.P., Antonov A.A., Vitkov A.A. et al. Morphological and functional retinal changes in postoperative hypotony. Russian Journal of Clinical Ophthalmology. 2021;21(4):187–193 (in Russ.). DOI: 10.32364/2311-7729-2021-21-4-187-193.

Prolonged use of selective immunosuppressants in glacoma drainage surgery: experimental in vivo study

Background: anti-inflammatory and antiproliferative agents are among tools to prevent postoperative scarring. Prolonged use of immunosuppressants characterized by a selective mechanism of action immediately at the surgical site. Aim: to assess the safety and efficacy of bio-resorptive drainage devices enriched with cyclosporine or everolimus in vivo. Patients and Methods: the study was conducted on 52 rabbit eyes. Before to the study, ocular surface disease provoked by the long-term use of preservative-containing IOP-lowering medications was simulated. The next step was the penetrating surgical procedure. The surgery involved implanting bio-resorptive drainage devices of polylactide enriched with cyclosporine or everolimus or control devices (neither cyclosporine nor everolimus). Postoperatively, all rabbits underwent regular ophthalmic exams and IOP measurements. Follow-up was 6 months. After 7 days, 1 month, and 6 months, the animals were slaughtered for the histology of surgical site. Results: better characteristics of filtering blebs and lower IOP values were seen among the animals who underwent surgical procedures with immunosuppressants compared to the control group even in the early post-op period. After 1 month, control filtering blebs stopped functioning and were characterized by the IBAGS H0 (height) and E0 (extent) in most animals. Meanwhile, in cyclosporine and everolimus groups, filtering blebs were characterized by the IBAGS Н1-Н2 and Е1-Е3 till the end of follow-up. After 6 months, mean IOP was 17.3±0.5 mm Hg in the control group and 13.0±0.4 mm Hg and 11.8±0.6 mm Hg in cyclosporine group and everolimus group, respectively. No significant differences between the groups were reported in terms of complications. Histology matched clinical data and illustrated the mechanism of increased outflow facility after the implantation of drainage devices enriched with immunosuppressants. Conclusion: in vivo experiment has demonstrated higher efficacy and similar safety of IOP-lowering surgery after the implantation of drainage devices enriched with selective immunosuppressants. Keywords: glaucoma surgery, immunosuppressants, cyclosporine, everolimus, drainage device, scarring, filtering bleb. For citation: Germanova V.N., Karlova E.V., Volova L.T. et al. Prolonged use of selective immunosuppressants in glacoma drainage surgery: experimental in vivo study. Russian Journal of Clinical Ophthalmology. 2021;21(2):78–85. DOI: 10.32364/2311-7729-2021-21-2-78-85.

A COMPARATIVE STUDY ON EFFICACY OF FIXED COMBINATION TIMOLOL/BRINZOLAMIDE VERSUS TRAVOPROST MONO-THERAPY IN DRUG-NAÏVE OPEN-ANGLE GLAUCOMA PATIENTS.

Background: Glaucoma is the cause of blindness. Beta blocker and prostaglandins are used as a first line treatment of open angle glaucoma. The exact target with mono therapy for reducing intraocular pressure is achieved within 2 years, so patient prefers fixed dose combination therapy. Objective: For reducing intraocular pressure efficacy, travoprost mono therapy and timolol/brinzolamide fixed dose combination therapy is compared. Material and methods: For 3 months, patients are randomly received 0.5% timolol and 0.2% brinzolamide twice daily and travporost once daily 0.004%.Then compared intraocular pressure, pulse rate, blood pressure, and cup disc ratio over 12 weeks of treatment. Results: 27.99% and 30.49% reduction in intraocular pressure is observed with mono therapy and fixed dose combination respectively. Pulse rate (9beats/min) and systolic pressure reduction by (2.35mmHg) were seen with fixed dose combination but no cup disc ratio observed. Conclusion: It is proved that 0.5% timolol and 0.2% brinzolamide causes more reduction in intraocular pressure than the 0.004% travporost mono therapy. Keywords: Glaucoma, travporost and lantoprost

Amygdalin protects apoptosis of retinal ganglionic cells in glaucoma rats by regulating the expressions of anti- and pro-apoptotic proteins

Purpose: To evaluate the protective effect of amygdalin against glaucoma.Methods: Glaucoma was induced in rats via ischemia/reperfusion. The rats were treated with amygdalin (1 mg/kg) intraperitoneally (ip) for 5 weeks. Intra-ocular pressure (IOP), viability of retinal ganglion cell (RGCs) and histopathological changes in the retinal tissue of the glaucoma rats were determined. The expression levels of inflammatory cytokines and expressions of apoptotic factors were assessed in retinal tissues of all groups.Results: Intra-ocular pressure was reduced in amygdalin-treated group, when compared with the glaucoma group (p < 0.05). Moreover, the viability and thickness of RGCs in the amygdalin-treated group were enhanced, relative to untreated glaucoma rats. There was decrease in retinal cytokinelevels in amygdalin-treated group, when compared with untreated glaucoma rats. Amygdalin treatment ameliorated altered expressions of apoptosis proteins in the retinal tissue of ischemia/reperfusioninduced glaucoma rats.Conclusion: Amygdalin has a protective effect against ischemia/reperfusion-induced glaucoma in rats. Thus, it has a potential for use in the clinical management of glaucoma. Keywords: Glaucoma, Amygdalin, Cytokines, Ischemia/reperfusion, Apoptosis