Therapeutic Role of Element Anhydrase Inhibitors in Treatment of Glaucoma: A Review

Eye disease may be a cluster of inveterately progressive disorders of the nervus opticus. during this article, I gift the medicine, Pathophysiology, risk factors, ophthalmic examination, and therapeutic role of carbonaceous anhydrase inhibitors in treating eye disease. In European countries, the prevalence of eye disease is a pair of.93% among persons aged 40-80 years, reaching ten you tired of persons over ninety years old-time. There is a unit many differing types of eye disease, and that they are classically divided into classes of open-angle and closed-angle eye disease. Use of topical selective or nonselective beta-blockers is used in the treatment of eye diseases. Second-line drugs of alternative embody alpha – agonists and topical carbonaceous anhydrase inhibitors. Parasympathomimetics drugs, most ordinarily alkaloid, area unit thought-about third-line treatment. For patients, the United Nations agency doesn't reply to antiglaucoma remedy, optical laser incisional and trabeculoplasty surgery area unit more ways that may be accustomed lower the pressure. The inhibitors area unit used medication in the treatment of symptom coronary failure, brain disease, and hypoxia conjointly. A Corollary of Friedenwald's construct of hydrogen carbonate secretion within the formation of liquid body substance is that inhibition of the protein carbonaceous anhydrase could be expected to decrease the speed of secretion and lower IOP. The carbonaceous anhydrase matter, Diamox (acetazolamide) is employed in the treatment of eye disease. Preliminary trials of Diamox in rabbits created a definite lowering of pressure to once ten to one hundred mg. carbonaceous anhydrase inhibitors diminish ocular high blood pressure in glaucomatous patients by reducing the hydrogen carbonate formation.

The Role of Optical Coherence Tomography in the Diagnosis of Angle Closed Diseases of the Anterior Chamber. Part 2: Visualization of the Posterior Segment of the Eye

The purpose of this work is to review the literature data on the role of optical coherence tomography in the diagnosis of diseases of the closed angle of the anterior chamber. The analysis of the use of modern technical devices — optical coherence tomography of the posterior segment, models with a frequency-modulated source (Swept Source) is presented. The emergence of new imaging technologies such as SS-OCT contributes to understanding the pathogenesis of primary angle closure diseases in terms of involvement of the choroid in the process. A thicker choroid in the macular area may be an anatomical risk factor for closed angle disease. The expansion of an abnormally thick choroid in combination with the structural features of the anterior segment in eyes with a short axial length, including against the background of psychoemotional stress, can lead to an attack of angle closure. Visualization of the structures of the posterior segment of the eye is an important part of the strategy aimed at solving the problem of identifying risk factors, diagnosing, monitoring and evaluating the effectiveness of treatment of diseases of primary angle closure. Qualitative and quantitative data analysis based on optical coherence tomography significantly increases the diagnostic accuracy, allows to determine its progression and to predict its course. This plays a key role in the choice of treatment tactics for the anterior chamber angle closure. The review considers the effect of local antihypertensive eye drops on the choroid.Conclusion. Optical coherence tomography is a standard in modern diagnostics and evaluation of the effectiveness of treatment of diseases of primary angle closure, allowing a better understanding of the pathogenesis of the disease and its complex nature. Imaging improves the ability to accurately diagnose and choose the right treatment strategy.

Comparative analysis of intraocular pressure dynamics after phacoemulsification with intraocular lens implantation in eyes with primary glaucoma

PURPOSE. To conduct a comparative analysis of changes in intraocular pressure (IOP) after cataract phacoemulsification with implantation of intraocular lens (IOL) in comorbidity with primary open-angle (POAG) and primary closed-angle glaucoma (PACG).METHODS. The study analyzed the dynamics of IOP changes after cataract phacoemulsification in 65 patients (89 eyes) with comorbid PACG and 46 patients (58 eyes) with comorbid POAG, aged 50 to 92 years. Thirty-five (53.85%) patients with POAG had history of glaucoma surgery, and 12 (20.69%) patients with PACG had been treated with laser iridectomy. The disease was in the initial stage in 14.6% of POAG patients and 5.15% of PACG patients; moderate stage — in 55.05% and 47.19%, respectively; advanced stage — in 30.34% and 24.14%. Intraocular pressure in POAG was compensated in 84.5% and subcompensated in 15.5% of patients; in PACG it was compensated in 77.6%, subcompensated in 12.6%, and uncompensated in 10.4% of patients. Compensation of IOP was achieved either by previous surgeries, or application of local antihypertensive medications. Patients with subcompensated and elevated IOP received the maximum possible amount of hypotensive medications. The follow-up period ranged from 1 month to 2 years.RESULTS. Patients were divided into three groups according to postoperative IOP levels: the first group with IOP equal to preoperative level, the second group — with IOP below the initial level, and the third group with IOP above the initial level. The IOP levels were consistent with preoperative values at all follow-up periods in most of study patients, and after 2 years their portion exceeded 70%, while in POAG it was somewhat higher than in PACG (77.42% against 71.43%). The IOP below the preoperative level was observed in eyes with initial and moderate open-angle and closed-angle glaucoma, with the amount decreasing with longer follow-up (from 63.16% at 3 months to 16.13% after 2 years in POAG, and from 62.74% to 19.04% in PACG). In the early postoperative period, number of POAG and PACG patients in this group was comparable, but after 8 months it included more PACG patients. Elevation of IOP in both forms of glaucoma was most often observed in faradvanced stage in the early post-op period after phacoemulsification, subsequently their number decreased and by two years it decreased by almost twice (6.45% vs. 11.84% in POAG and 9.53% vs. 15.69% in PACG). During the entire follow-up period, the number of patients with ophthalmic hypertension in PACG was 30% higher than in POAG.CONCLUSION. The study showed that in most cases phacoemulsification has a stabilizing effect in patients with cataracts in combination with glaucoma. The hypotensive effect of the operation was observed in initial and advanced stages of glaucoma, when the drainage system of the eye was still preserved, and in the long term it was observed in a larger percentage of cases in angle-closure glaucoma compared to open-angle glaucoma. An increase in intraocular pressure relative to the preoperative level was observed in advanced glaucoma throughout the entire follow-up period, and the number of patients with angleclosure glaucoma was one-third higher than the number of patients with open-angle glaucoma. The obtained ambiguous results of intraocular pressure measurements after phacoemulsification of cataract with implantation of IOL in combination with various forms of glaucoma dictate the need for further study of this problem.

The Role of Optical Coherence Tomography in the Diagnosis of Angle Closed Diseases of the Anterior Chamber. Part 1: Visualization of the Anterior Segment of the Eye

The purpose of this work is to review the literature data on the role of optical coherence tomography in the diagnosis of diseases of the closed angle of the anterior chamber. An analysis of the modern technical devices use — optical coherence tomography of the anterior segment (AS-OST) and models with a frequency-modulated source (Swept Source) is presented. The advent of new imaging technologies such as SS-OCT is advancing the understanding of the pathogenesis of primary angle closure diseases. Visualization of the structures of the anterior segment of the eye is an important part of the strategy aimed at solving the problem of identifying risk factors, diagnosing, monitoring and evaluating the effectiveness of treatment of diseases of primary angle closure. Qualitative and quantitative data analysis based on optical coherence tomography significantly increases the diagnostic accuracy, which undoubtedly plays a key role in the choice of treatment tactics for the closed angle of the anterior chamber. The interpretation of research results should take into account the strengths and weaknesses of traditional methods and newly developed technologies.Conclusion. Optical coherence tomography of the eye’s anterior segment is a standard in modern diagnostics and evaluation of the effectiveness of treatment of diseases of primary angle closure, taking into account pathogenetic mechanisms.

COMPARISON OF GONIOSCOPY AND ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY IN THE ASSESSMENT OF ANTERIOR CHAMBER ANGLE IN GLAUCOMATOUS PATIENTS OF A TERTIARY CARE HOSPITAL OF KUMAOUN REGION

AIM:To nd the role of gonioscopy and anterior segment optical coherence tomography in detecting angle closure in different quadrants of anterior chamber angle in glaucomatous patients. Study design:Cross sectional study Material and Methods:65 patients with age >10 years of age with suspected angle closure were recruited from a tertiary care hospital in Kumaon Region. Subjects underwent gonioscopy and AS- OCT imaging in dark.Gonioscopy as gold standard , the ACA was graded using the Spaeth system by a two examiners masked to each other ndings then the results of both the techniques were compared. Results: 130 eyes of 65 patients studied. The angles in all quadrants compared between Gonioscopy and AS-OCT using chi-square test.Closedangle were found to be 5.4%(7%) with AS-OCT and 13.8%(18) with Gonioscopy in superior quardant. Closed-angle were more with Gonioscopy 10.8%(14) as compared to AS-OCT5.4%(7) in inferior quadrants. In temporal qudrant closed-angle with gonioscopy was 11.5%(15) as compared to AS-OCT 5.4% (7). Closed-angles with gonioscopy in nasal quadrant was 12.3%(16) as compared to 5.4%(7) in AS-OCT. Conclusion: AS-OCT is highly sensitive to detect closed angles, probably due to the dark ambient condition and its non-contact nature.With the 3600 analysis, the regional differences or quadrants can be evaluated which are either partially closed or open. Considering angle closure in terms of percentage or degrees could be more accurate than more limited cross-sectional assessment. Gonioscopy showed more number of closed angles as compared to AS-OCT.The angles which seemed closed on gonioscopy were found open in AS-OCT.

Anisocoria in an intubated patient with COVID-19

The effects of COVID-19 on the eye are still widely unknown. We describe a case of a patient who was intubated and proned in the intensive care unit (ICU) for COVID-19 and developed unilateral anisocoria. CT venogram excluded a cavernous sinus thrombosis. MRI of the head showed microhaemorrhages in the midbrain where the pupil reflex nuclei are located. After the patient was stepped down from ICU, intraocular pressure (IOP) was found to be raised in that eye. A diagnosis of subacute closed angle glaucoma was made. It is important for clinicians to rule out thrombotic causes in patients who develop acute anisocoria. It is also crucial to measure IOP in patients who develop ophthalmic pathology and have been proned for extended periods.

Optimization of surgical treatment of secondary closed-angle glaucoma in patients with organic block of the anterior chamber angle

Purpose. Optimization of surgical treatment of secondary closed-angle glaucoma in patients with organic block of the anterior chamber angle. Material and methods. The analysis of the results of 6 AGO using autologous scleral drains treated with MMC is presented in children with an organic block of the anterior chamber angle without the phenomena of neovascularization is privided. Five children had uveal glaucoma; one child had an essential mesodermal iris dystrophy with secondary glaucoma. In all cases before the formation of autologous scleral drains, intraoperative applications of MMC were performed, followed by a plentiful washing of the operating field with normal saline solution. The duration of follow-up was from 1.5 to 7 years. Results. The operations proceeded without complications. There was a long choroidal edema on one eye in the early postoperative, stopped with the help of conservative treatment for 10 days. In the long term, on one eye in the period of exacerbation of uveitis, dislocation of autodrainages arose, which was facilitated by the appearance of exudative effusion in the anterior chamber. Later on this eye the failure of the AGO developed. On the other eyes, the intraocular pressure remained compensated, and the functions were stable. Conclusion. Treatment of drainages from the autosclera with MMC before implanting them into the anterior chamber of the eye, in patients with organic block of the anterior chamber angle, is effective against the hypotensive effect of the operation and is safe for intraocular structures while observing the processing technique. Key words: secondary closed-angle glaucoma, anterior chamber, autologous