A new algorithm of treatment choice in primary open-angle glaucoma

Purpose: to develop a comprehensive algorithm for choosing the optimal method for monitoring and treating patients with primary openangle glaucoma (POAG). Material and methods. 30 patients with POAG, aged 30 to 86, underwent an ophthalmological examination which included visometry, standard automatic perimetry, tonometry, ophthalmoscopy, and biomicroscopy. The data obtained were evaluated on a point scale according to the innovative algorithm, on the basis of which a plan of patient management was recommended. Then the recommendation of the algorithm was compared with the suggestion of an expert specializing in the treatment of glaucoma. Results. The proposed innovative algorithm for treating POAG patients sets up four stages in the appointment of topical hypotensive therapy. When gaining a certain number of points, the algorithm recommends surgical treatment. The treatment tactics suggested by the algorithm, agreed with the opinion of glaucoma expert in most of the cases (27 out of 30 cases; 90%). Conclusion. An algorithm for the treatment of patients with POAG has been proposed and tested. The algorithm makes it possible to assess the progression of the glaucomatous process and select the optimal tactics for managing the patient in real time of examination.

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

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.

Comparative effectiveness of interventions for improving adherence to ocular hypotensive therapy in patients with glaucoma or ocular hypertension: protocol for network meta-analysis

IntroductionPoor medication adherence is an important issue in healthcare. Various types of interventions for improved adherence to ocular hypotensive therapy have been proposed, though evidence on the effectiveness of any isolated intervention remains limited. The current protocol is an ongoing network meta-analysis (NMA) design that enables comparative investigation of any and all interventions for which there are available randomised controlled trials (RCTs). Our aim is the systematic comparison of the efficacy of different types of adherence interventions for patients suffering from glaucoma or ocular hypertension (OHT).Methods and analysisStudies of interest will assess the effects of any interventions on medication adherence in adults (age ≥18 years) with either glaucoma or OHT. Four electronic databases (Cochrane Central Register of Controlled Trials, Embase, MEDLINE and Scopus) will be searched for RCTs published in any language, without any time limitation. First, titles and abstracts, and then full-text papers, will be screened by two reviewers, who will extract the useful data. The primary outcome measure is an intervention’s impact on adherence. The two reviewers will also assess, using the relevant domain-based risk-of-bias assessment tool, the internal validity of the studies. The overall quality of the evidence will be assessed by the Confidence in Network Meta-Analysis approach, and will be summarised with network diagrams. To allow for assessment of both direct and indirect evidence, a contribution matrix will be used. For visualisation of the effects of all of the included interventions, forest plots will be constructed. Pairwise effect sizes will be calculated according to all of the evidence available in the network.Ethics and disseminationThis work will synthesise evidence from already published studies and, as such, will not require an ethics review or approval. A manuscript presenting the findings will be submitted to a peer-reviewed scientific journal for publication.PROSPERO registration numberCRD42021253145.

Factors of Excessive Proliferation after Trabeculectomy in Pediatric Uveitic Glaucoma

Objective: to study efficacy and factors of excessive proliferation after trabeculectomy (T) in pediatric uveitic glaucoma (UG).Patients and Methods. 102 children aged from 3 to 17.5 years (mean 124.5 ± 2.8 month) with uncontrolled on maximum topical hypotensive therapy open angle or combined (with peripheral anterior synechiae) form of UG underwent T (148 eyes, 180 operations). 76.1 % operations were performed with intraoperative 5-fluorouracil, 8.3 % — with mitomycin C, 6.1 % — with bioresorbable, 1.7 % — with collagen drainage, 7.8 % — without antimetabolites or drainages. Kaplan-Meier survival analysis was performed.Results. Overall absolute (without hypotensive therapy) success probabilities were 67 %, 46 %, 39 %, qualified success (with hypotensive therapy) — 93 %, 72 %, 54 % at 1, 3, 5 years after T respectively. Factors associated with failure were primary location of inflammation in anterior uvea, aphakic or pseudophakic eye, repeat T, bioresorbable drainage (vs. 5-fluorouracil), persistent inflammation after T. Age and uveitis activity at the moment of T, duration hypotensive therapy before primary T, postoperative complications (9.4 %), frequency of postoperative topical steroid had no significant influence on surgical success.Conclusion. T with intraoperative antimetabolites is effective, safe and nowadays may be recommended as first choice operation in pediatric open angle or combined UG.

Complex technology of laser surgery for pigmentary glaucoma

Purpose. To analyze the complex method effectiveness of pigmentary glaucoma laser surgery (YAG-laser iridectomy and a multistep SLT). Materials and methods. Laser iridectomy was performed in 14 patients (28 eyes) aged 13 to 54 years old with pigmentary glaucoma after achieving the values of the individual IOP level against the background of drug therapy. Then after 4 weeks SLT was carried out. If an exogenous pigmentation was ≥2 st., SLT repeated several times every 4-6 months. Observation period: from 4 to 15 years. Results. The glaucoma process stabilization was achieved in all cases. The level of true IOP decreased by 6.6±0.3 mm Hg (-30%, p<0.05), Becker's coefficient by 121±4.3 (-60%, p <0.001), the instillations number by 1.32±0.06 (-70%, p<0.001). The indicators increased: the average value of the total retinal photosensitivity by 381±4.3 dB (15%, p<0.001), the average threshold of the retinal photosensitivity by 2.6±0.1 dB (10%, p<0.001), the lightness of the intraocular liquid outflow by 0.08±0.013 (72%, p<0.001). Drug hypotensive therapy was canceled at 12 eyes (42.8%). Conclusion. The complex method of pigmentary glaucoma laser surgery in the form of YAG-laser iridectomy and the multistep SLT is effective and safe. It can be performed for a decrease of increased ophthalmotonus level to the individual IOP against the background of drug treatment. Key words: pigmentary glaucoma, YAG-laser iridectomy, selective laser trabeculoplasty.

Modern principles of treatment of arterial hypertension in patients with chronic kidney disease and glomerulonephritis

The literature review presents current international data on the principles of choice of hypotensive therapy tactics in patients with chronic kidney disease and glomerulonephritis. safe levels of blood pressure reduction, reflected in the regulatory documents of European and American nephrological and cardiological associations, methods of their control are discussed. Data on the nephroprotective effects of the main classes of hypotensive drugs – angiotensin-converting enzyme inhibitors and angiotensin receptor blockers – are presented. The necessity of monitoring the safety of hypotensive therapy in glomerulonephritis with chronic kidney disease using methods of blood pressure monitoring is emphasized.

Dynamics of intraocular pressure and central corneal thickness in patients with open-angle glaucoma in short-term period after cataract phacoemulsification

A study of IOP and ССТ in patients with open-angle glaucoma in the dynamics after cataract phacoemulsification, the timing of normalization of these indicators was performed. An increase of IOP was noted in 50.0 % of patients, which required increased hypotensive therapy, in 18 % of patients antiglaucoma surgery was performed against persistent decompensation of pressure. Key words: open-angle glaucoma; cataract phacoemulsification; reactive ophthalmic hypertension.

Features of the course and treatment of glaucoma during pregnancy

In the review we have integrated all up-to-date knowledge concerning clinical course and treatment of glaucoma among pregnant women to help specialists choose a proper policy of treatment for such a complicated group of patients. Glaucoma is a chronic progressive disease. It rarely occurs among childbearing aged women. Nevertheless the probability to manage pregnant patients having glaucoma has been recently increasing. The situation is complicated by the fact that there are no recommendations on how to treat glaucoma among pregnant women. As we know, eye pressure is progressively going down from the first to the third trimester, so we often have to correct hypotensive therapy. Besides, it is necessary to take into account the effect of applied medicines on mother health and evaluate possible teratogenic complications for a fetus. The only medicine against glaucoma which belongs to category B according to FDA classification is brimonidine. Medicines of the other groups should be prescribed with care. Laser treatment or surgery may also be a relevant decision when monitoring patients who are planning pregnancy or just bearing a child. Such treatment should be also accompanied by medicines.

Effect of Early Controlled Hypotension on Patients with Traumatic Brain Injury

Objective: To investigate the clinical effect of early controlled hypotensive therapy in patients with traumatic brain injury (TBI). Methods: 68 patients with acute TBI in our hospital were selected for this investigation. They were evenly divided into a control group and an observation group according to the difference of blood pressure and basic level, whose lesion area after treatment, postoperative intracranial pressure after 2d and 7d, and GCS score of prognostic quality before and after treatment were made comparison. Results: The post-treatment lesion area of the observation group was lower than that in the control group (P<0.05); the postoperative intracranial pressure after 2d and 7d of the control group was better than the observation group(P<0.05), and the same with GCS score, which has statistical significance (P<0.05). Conclusion: Early controlled hypotensive therapy has a significant clinical effect on patients with brain trauma, it can reduce the lesion area after treatment and postoperative intracranial pressure as well.