Vascular and vegetative factors of glaucoma attack

Purpose. To study the involvement of vascular and vegetative factors in the pathogenesis of glaucoma attack. Material and methods. 12 patients (24 eyes) aged 49 to 82 — 5 men and 7 women, including 3 patients with acute glaucoma and 9 patients with subacute glaucoma were subjected to an ophthalmological examination that included visometry, tonometry, automated static perimetry, OCT and OCT angiography. They were also tested for heart rate variability (HRV) using a Polar heart rate monitor, and for plasminogen content and products of fibrin/fibrinogen degradation in the tear. For comparison, the contralateral eyes of these patients were examined. Results. In the eyes with an acute glaucoma attack, the vascular network was noticeably weakened, especially in the area of the deep peripapillary vascular plexus at the lamina cribrosa level, and focal capillary loss was observed. The peripapillary density of the deep vascular plexus in the eyes with an acute attack was 33.0 ± 5.6 % (М ± m), which was significantly (p < 0.01) lower as compared to 50.0 ± 4.7 % in the unaffected eyes. This indicator correlated with the thickness of the ganglion cell complex (GCC) (p < 0.01). In unaffected eyes, no correlations were found between these glaucoma-related parameters. A significant amount of fibrin/fibrinogen degradation products was found in the tear of glaucoma patients, which may point to a violation of blood circulation in the optic nerve vessels. It has been established that glaucoma attack occurs with increased activity of sympathetic regulation of blood flow. Conclusion. When monitoring this contingent of patients, it is essential to determine the sympathetic-parasympathetic status of the patient. Taking into account the vascular component of the condition, it is expedient to introduce the necessary additions into its treatment plans

Pathogenetic Justification of a New View on the Treatment of Angle-Closure Glaucoma

Purpose. To study the effectiveness of vascular, anti-inflammatory and fibrinolytic therapy, to conduct a comparative assessment with treatment without vascular therapy in patients with angle-closure (ACG) and mixed glaucoma.Methods. A total of 55 patients with angle-closure and mixed glaucoma, mainly with hypermetropic refraction of varying degrees, were examined: 7 people with acute glaucoma attack, 6 people with subacute glaucoma attack (group 1, with anti-inflammatory treatment), 7 people with acute glaucoma attack and 6 people with subacute glaucoma attack (group 2, with vascular treatment), 14 people with chronic angle-closure glaucoma (group 3) and 15 people with mixed glaucoma (group 4). All patients underwent an ophthalmological examination, which included visometry, refractometry, tonometry, computer perimetry, OCT and OCT angiography, and an ELISA analysis to determine cytokines.Results. The administration of the drug Pentoxifylline as a cytokine blocker and antiplatelet agent in ACG contributed, in our opinion, to an improvement in visual acuity, perimetry (MD), an increase in the density of capillaries of the deep vascular plexus at the level of lamina cribrosa in the peripapillary zone (%), i.e. improved blood circulation in the vessels of the optic nerve disc and also contributed to the blockade of cytokines, mainly in the 2-nd group of patients. In our opinion, a personalized approach to the treatment of ACG is to maintain the improvement of blood circulation in the peripapillary zone by prescribing a course of treatment with Pentoxifylline for 6 months after surgery. After phacoemulsification, there was a significant increase in the density of capillaries of the deep peripapillary vascular plexus at the level of lamina cribrosa (p ≤ 0.05) (51.0 ± 3.5 %), and after further treatment with Pentoxifylline, the capillary density continued to increase in 2–4 groups in the next 6 months of follow-up. The thickness of RNFL (Retinal nerve fiber layer, structural parameter) decreased due to a decrease in edema in 1–2 groups, slightly increased in 3–4 groups, in our opinion, due to improved blood circulation. Increased reperfusion in the capillaries of the deep plexus during normalization of IOP in glaucoma patients and further treatment with pentoxifylline indicates the effectiveness of the proposed treatment in addition to surgical treatment. The results obtained emphasize the advantages of the proposed therapy for the treatment of patients with angle-closure and mixed glaucoma.Conclusion. To date, there are no clear recommendations of vascular therapy for the treatment of patients with ACG and mixed glaucoma, which creates the need for its addition to treatment regimens, taking into account the vascular component of ACG and mixed glaucoma.

Expression of Slit2 and Robo Receptors in a Sprague-Dawley Rat Glaucoma Model

Background: This study investigated immunoreactive changes in Slit2 and Robo receptors in the retinal ganglion cell layer of a rodent model of acute glaucoma. Methods: Glaucoma model using Sprague-Dawley rats was made via weekly intracameral injections of hyaluronic acid. Intraocular pressure (IOP) was measured twice weekly for 4 weeks using a rebound tonometer in an experimental group of 10 rats and a control group of five rats for 4 weeks. The trimmed retinas were processed for anti-glial fibrillary acidic protein (GFAP), anti-Slit2 and anti-Robo1, anti-Robo2, anti-Robo3 and anti-Robo4 immunochemical analysis. Result: The IOPs in the experimental group were approximately four times higher than IOPs in the control group. The GFAP, Slit2 and Robo4 immunoreactivity in the experimental group was higher than the corresponding values in the control group. Our results indicate that Slit2 and Robo4 potentially contribute to the progression of high tension glaucoma, especially in inducing ischemic injury.

The Effect of Levamlodipine in Glucose-Induced Acute Model of Glaucoma in Rabbits

BACKGROUND: Loss of vision and irreversible blindness are the main consequences of glaucoma. There are two main types of glaucoma: Chronic and acute. AIM: This work aimed to evaluate the intraocular effect of levamlodipine on the acute model of glaucoma in rabbits. METHODS: Eighteen white albino rabbits of both sexes weighing about 2 kg. We divided them into three groups (six animals in each group) used in the experiment. We use the right eye to evaluate the effect of the test drug and used the left eye as a control (vehicle only). We used the first group to evaluate levamlodipine (0.25%), the second group to estimate levamlodipine (0.5%), and the third group to assess pilocarpine 2% (positive control). Drugs were administered 30 min before induction. RESULTS: Glucose (5%) fluid produces a significant intraocular pressure (IOP) elevation after 30 min of administration in the left eye (p ˂ 0.001). Pre-treatment topical administration of levamlodipine (0.25%) prevents the rise in the IOP significantly (p ˂ 0.001) in the right eye when compared to the control group (left eye). Moreover, compared with the eyes of the control group at all stages of the experiment, the topical administration of levamlodipine (0.5%) has a significant preventable effect (p ˂ 0.001), compared with the control group. The IOP of the local pilocarpine (2%) in the third group was significantly decreased (p ˂ 0.001). Finally, compared with levamlodipine (0.5%), pilocarpine has a more significant effect in preventing a rapid increase in intraocular pressure (p ˂ 0.001). CONCLUSION: Levamlodipine is a promising therapeutic agent for patients vulnerable to acute glaucoma.

Clinical case of successful treatment ocular hypertension caused by organic closure of anterior chamber angle after penetrating keratoplasty

Clinical case of successful treatment ocular hypertension caused by organic closure of anterior chamber angle after penetrating keratoplasty is presented. The patient underwent keratoplasty in the right eye and on the first day after the operation the clinic of acute glaucoma attack in the operated eye was revealed. In view lack of effect from medication and laser treatment carried out, the synechiae surgical removal was done. Carbachol Intraocular Solution (0.1 ml MIO-CHOL Sterile Solution, APPASAMY OCULAR DEVICES (P) LTD. (PHARMA DIVISION), India) was injected into anterior chamber to narrow the pupil. But its action turned out to be paradoxical – instead of constriction there was sharp pupil dilation. In addition to standard treatment, the patient received keratoprotection and reparative therapy. To restore neurotrophic processes in the iris, intravenous infusions of 1000 mg of gliatilin were first performed, followed by a switch to the tablet form of this drug. After 4 months, the patient experienced increase in uncorrected visual acuity to 0.1; best corrected visual acuity – up to 0.2 with diaphragm against the background of complete absence of signs of inflammation. The graft was completely transparent, the intraocular pressure – 19 mm Hg, mydriasis persisted 5–6 mm, the reaction of the pupil to light appeared, but was weakened. Key words: ocular hypertension after penetrating keratoplasty, acute glaucoma attack, synechiae surgical removal.

Acute glaucoma mimicking trigeminal autonomic cephalalgias: a case report

Context: Trigeminal autonomic cephalalgias (TAC) are unilateral and recurrent headache with ipsilateral cranial autonomic symptoms such as lacrimation, conjunctival injection, ptosis and changes on pupillary diameter. Acute glaucoma is a rare etiology of headache in the emergency room and can be confused with TAC because it also presents with similar symptoms in the affected eyes. Case report: We present a case report of a 50-year-old insulin-dependent diabetic woman with severe headache that started the day before admission. The headache was left hemicranial, pulsatile and associated with ipsilateral lacrimation. On physical examination we observed mild conjunctival hyperemia, ptosis, visual loss of 20/800 and fixed mydriasis in left eye. Because of the visual loss the patient was referred for urgent ophthalmological evaluation that revealed high intraocular pressure (41 mmHg) and neovascularization of the iris, suggesting the diagnosis of acute glaucoma associated with the neovascularization related to diabetes mellitus. Conclusions: Acute glaucoma should be distinguished from TAC given the overlap of severe headache and ipsilateral eye symptom. However, the presence of fixed mydriasis and progressive visual loss suggested the diagnosis of acute glaucoma, since in TAC miosis is the usual pupillary alteration, as a consequence of parasympathetic overactivation, and visual loss is uncommon.