Analysis of changes in structural and hemodynamic parameters of the retina and foveolar avascular zone in patients with primary open-angle glaucoma and diabetes mellitus observed in long-term follow-up

PURPOSE. To study the changes in structural and hemodynamic parameters of the retina and foveolar avascular zone (FAZ) over time in patients with primary open-angle glaucoma (POAG) and diabetes mellitus (DM) observed in long-term follow-up.MATERIALS AND METHODS. The study included 258 patients (258 eyes) divided into five groups: group 1 — 58 patients (58 eyes) with stage I POAG and DM; group 2 — 50 patients (50 eyes) with stage I POAG; group 3 — 50 patients (50 eyes) with stage III POAG and DM; group 4 — 50 patients (50 eyes) with stage III POAG; group 5 — 50 patients (50 eyes) with DM. Patients underwent comprehensive ophthalmological examination, spectral domain optical coherence tomography (SD-OCT), optical coherence tomo-graphy angiography (OCT-A) of the macular region. The follow-up lasted 24 months.RESULTS. Analysis of the initial parameters in groups of patients with comorbidities showed the lowest values compared to controls, which were progressively worsening. MD in the group with DM + stage I POAG had reliably decreased after 12 months (by 5.05%), after 24 months by 12.12% (p≤0.05). The speed of GCL+IPL loss in groups 1 and 3 during the first year of observation was almost equal for initial and advanced glaucoma — 1.35 (-2.03%) and 1.32 (-2.36%) µm/year, but in group 3 the loss had doubled after two years (2.48 (-4.44%) and 1.41 (2.12%) µm/year). Deterioration of hymodynamic parameters in the macular region in groups 1 and 3 was noted primarily in the inner sectors (whole image vessel density in parafovea (PF wiVD) -0.79% during the first, and -2.57% during the second year in initial glaucoma, -0.6% and -1.24% in advanced, whole image vessel density in parafovea (PF wiVD) -0.2% and -1.22%, -0.66% and -1.56%, respectively). Parameters of FAZ had changed significantly after 2 years in patients with stage I POAG and DM: its area size had increased by 10.2%, perimeter by 4.49%, circularity index had decreased by 3.17%.CONCLUSION. Comorbidity of POAG and DM is accompanied by development and quick progression of significant changes in structural and hemodynamic parameters of the retina as observed by this long-term follow-up.

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.

General ophthalmological aspects of the COVID-19 infection

The COVID-19 pandemic has gone down in history as an international emergency that resulted in the death of millions of people. The coronavirus infection poses a large number of problems for medical science and, in particular, ophthalmology, which for the most part do not have obvious solutions. Due to insufficient knowledge about coronavirus infection in ophthalmology, there is a lack of understanding of eye symptoms, methods of prevention, treatment and organization of healthcare for such patients during a pandemic. Based on the available studies researching these issues, it is assumed that the virus may directly affect the ocular surface tissues (conjunctiva, cornea). Also, the possibility of transmission of infection through the ocular surface has not been ruled out. The data indicate the need to expand the measures for prevention of the spread of coronavirus infection, including through the surface of the eye.

Combined treatment of post-thrombotic neovascular glaucoma (clinical case study)

PURPOSE. To present the features of the clinical course and evaluate the effectiveness of laser and surgical treatment of patients with neovascular glaucoma following central retinal vein thrombosis.MATERIALS AND METHODS. Two patients with neovascular glaucoma secondary to central retinal vein thrombosis were examined. Surgical interventions were performed: patient M. — micropulse cyclophotocoagulation (twice), intravitreal administration of an angiogenesis inhibitor (5 injections), retinal laser coagulation (two-stage); patient E. — micropulse cyclophotocoagulation, intravitreal administration of an angiogenesis inhibitor (2 injections), implantation of the Ahmed valve.RESULTS. The treatment resulted in compensation of intraocular pressure (IOP), improvement of visual functions, reduction of neovascularization in the structures of the anterior eye segment.CONCLUSION. Micropulse cyclophotocoagulation can be used in the complex treatment of neovascular glaucoma at any stage in order to reduce IOP and decrease the neovascularization in the iris and anterior chamber angle structures in the postoperative period.

Efficiency of brinzolamide and its combinations with timolol maleate in the treatment of primary open-angle glaucoma

PURPOSE. To evaluate the effectiveness of 1% brinzolamide solution (Brineks-M) and its combination with 0.5% timolol maleate solution (Brinarga) in the treatment of patients with primary open-angle glaucoma (POAG).METHODS. The study involved 56 patients (56 eyes) with initial or moderate POAG and normal or moderately increased intraocular pressure. Individually tolerated IOP, hydrodynamic parameters, hemodynamic parameters of the eye (by computer ophthalmoplethysmography), microcirculation (by OCT angiography of the optic nerve head) were determined during the study.RESULTS. The hypotensive effect of 1% brinzolamide solution (Brineks-M) in patients with the early stage of POAG (23 eyes) after 3 months was 22.5%. The antihypertensive effect of Brinarga in patients with early and moderate stages of POAG (33 eyes) was 31.3% and persisted for 3 months of observation.CONCLUSION. A decrease in IOP to an individually tolerable level was accompanied by an improvement in ocular hemodynamics and microhemocirculation of the optic nerve head, and stabilization of visual functions in patients with POAG.

The role of B vitamins in preventing the progression of glaucomatous optic neuropathy

The literature review discusses the role of vitamins (in particular, B vitamins) in maintaining neuroprotective and antioxidant properties of the retina in glaucomatous optic neuropathy, and presents the data from foreign research papers devoted to studying the positive influence of vitamins of this group on the condition of ganglion cells of the retina and axons of the optic nerve.

Evaluation of repeated micropulse cyclophotocoagulation in patients with refractory glaucoma

PURPOSE. To evaluate the efficacy and safety of repeated micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with previously operated refractory glaucoma.MATERIALS AND METHODS. We examined 89 patients aged 74.2±7.3 years with moderate (16), advanced (58) and terminal (15) stages of uncompensated primary openangle glaucoma (POAG) before and within 12 months after the first MP-TSCPC (SUPRA 810, “Quantel Medical”, France) using standard laser parameters — 100 J. Indications for repeated MP-TSCPC were determined for 23 patients in 3 (1 patient), 6 (14 patients), 9 (8 patients) months after the first procedure. Repeated MP-TSCPC was carried out with higher impact energy — 125 J.RESULTS. After the first procedure, the hypotensive effect was achieved in 66 (74.2%) patients with refractory glaucoma lasting up to 12 months of follow-up. Repeated MP-TSCPC in 23 patients reduced the IOP by 31.2% in moderate, 31.8% in advanced, and 22.9% in terminal stages (p<0.05) by 6 months of follow-up. As a result, during 12 months of observation, MP-TSCPC (single and double) led to stabilization of the IOP in 83.1% of cases.CONCLUSION. Single and repeated micropulse TSCPC with laser energies of 100 J and 125 J is an effective and safe method of treating patients with refractory glaucoma. A single MP-TSCPC with laser energy of 100 J was effective in 66 (74.2%) patients by 12 months of observation, and single followed by repeated (laser energy of 125 J) — in 74 (83.1%) patients. It is possible to revise the basic parameters of the MP-TSCPC procedure from 100 to 125 J to achieve a longer and at the same time safe hypotensive effect in patients with refractory glaucoma.

Perimetry as a technique from the standpoint of practicing ophthalmologists

PURPOSE. To study the needs of practical ophthalmologists concerning the functionality and performance of automatic perimeters, and offer a possible solution to meet these needs.METHODS. An online survey of Russian ophthalmologists was organized and conducted. The survey was attended by specialists representing various medical institutions and medical research centers. As a result of the survey, 132 filled questionnaire forms were received and analyzed using the Kano and 4C models.RESULTS. According to experts, it is necessary for ophthalmologists to have an accessible automatic perimeter equipped with the screening (for the initial examination of patients) and threshold (to clarify the depth of photosensitivity disturbance of detected visual field defects) strategies. The general requirements for the functional characteristics of the screening and threshold tests of the automatic perimeter have been determined: small variability of repeated results, the speed and simplicity of the study — particularly, by employing the Frequency Doubling Technology (FDT), a non-standard perimetry technique. The requirements of users for the operational method of the automatic perimeter have been determined: absence of the need for a specially prepared room and place, mobility, portability, maximum ease of use to ensure the possibility of performing screening and primary diagnostics outside medical institutions, including by mobile medical teams, and also to allows examinations of individuals with disabilities, including bedridden patients, both in the hospital and at home.CONCLUSION. Based on the study data, the needs of ophthalmologists in the functional and operational characteristics of modern automatic perimeters were identified showing that the automatic perimeters presently used by modern medical institutions are far from optimal in terms of their properties/characteristics. These devices do not allow perimetry to be performed on patients with disabilities, including bedridden patients, neither at home nor in the hospitals. In addition, these devices require a darkened room, they are difficult to use, while their licensing documentation states that only ophthalmologists can conduct the examinations. Manufacturers do not offer solutions tailored to the individual needs of specific user groups — outpatient ophthalmologists who in particular work with disabled patients.

Epidemiological features of glaucoma prevalence among the population of the Russian Federation

PURPOSE. To study the epidemiological features of glaucoma prevalence among the population of the Russian Federation and to assess the organization of primary specialized medical care for patients with this pathology.MATERIALS AND METHODS. The subject of this study was the population of the Russian Federation diagnosed with glaucoma. In order to assess the epidemiological features of glaucoma prevalence and to assess the organization of primary specialized medical care for patients with this pathology, according to the federal statistical reporting forms (Forms No. 12, No. 30), the following indicators were calculated: overall and primary incidence of glaucoma in the general population; proportion of patients with glaucoma who are registered with ophthalmologists; availability of ophthalmologists (individuals) per 100 thousand population; proportion of patients with glaucoma diagnosis established during preventive examinations; total number of registered patients with blindness and visual impairment. Statistical processing of the material involved methods of descriptive statistics; calculation of average and relative values with a preliminary assessment of the distribution of indicators for normality. Spearman rank correlation method was used to determine the correlation between quantitative variables.RESULTS. The studied data was used to calculate the following average values: total and primary glaucoma incidence among the population of the Russian Federation — 78.2 (55.8–105.3) cases per 100 thousand population; the proportion of patients with dispensary registered glaucoma — 80% (74.4–85.8%). The performed correlation analysis established a moderate direct statistically significant relationship between the indicators of total and primary glaucoma incidence among the population (rank correlation coefficient: r=0.72 at p<0.05). In its turn, the correlation between the indicators of glaucoma incidence among the population and the availability of ophthalmologists for the population has not been established (r=0.14, p>0.05). It was found that the indicators of dispensary observation of glaucoma patients do not depend on the indicators of total glaucoma incidence (r=0.16) and availability of ophthalmologists for the population (r=0.13). There is a weak inverse correlation between the proportion of glaucoma cases detected during preventive examinations and the indicator of primary glaucoma incidence among the population (r=-0.28; p<0.05). Also, the correlation analysis did not establish a relationship between the indicator of total glaucoma incidence among the population and the total number of registered patients with blindness and low vision (r=-0.008).CONCLUSION. The incidence rate of glaucoma in specific administrative territories should be assessed by comparison with the average values among the whole population, which are represented by the median and quarterly ranges. The incidence rate of glaucoma in the general population is not statistically related to the level of availability of ophthalmologists for the population. The proportion of follow-up observation of glaucoma patients does not depend on the availability of ophthalmologists and the level of glaucoma incidence. The incidence of blindness and low vision does not statistically correlate with the incidence of glaucoma in the population.

The profile of patients with primary open-angle glaucoma in the Russian Federation (preliminary results of a multicenter population-based study). Part 2

PURPOSE. To determine individual clinical and epidemiological characteristics of the disease in patients with primary openangle glaucoma (POAG) and to establish its relationship with adherence to treatment.METHODS. The analytical, multicenter, combined study involved 1 092 subjects (2 184 eyes) with different forms of glaucoma (general group) were selected using a survey, followed by their clinical and epidemiological analysis.RESULTS. When verifying the diagnosis, eyes with POAG prevailed in the main group (from 89.6 to 92% of all eyes). The average age in the main group at the final examination was 66 (63; 69) years, the duration of the disease was on average 3 years. The number of eyes with the initial stage of glaucoma decreased in 3 years by 17.5-19.1%, and the number of eyes with advanced and severe stages of the disease increased by 10.4-12.9% and 5.1-5.2%, respectively. The hypotensive regimen was changed at the average tonometric intraocular pressure of 24 (23; 26) mm Hg (regardless of the disease stage). When estimating the comorbidity of the main group, the most common concomitant somatic pathology was hypertension. Today, prostaglandin analogues are prescribed in 34.6-36.3% of all cases for all stages of glaucoma. The leading complaint of patients according to the survey was the cost of treatment. In addition, the influence of the organization's pharmacist on the choice of the purchased drug was revealed. However, attending physician remains the main source of information about the disease for patients (92.2%).CONCLUSION. It was found that POAG predictably prevails in Russia, and its diagnosis still comes with a delay. The causes of treatment failures should be recognized as late diagnosis, incorrect treatment of patients with newly diagnosed condition, and the same treatment regimens for paired eyes with different stages of POAG, as well as social and behavioral factors of patient compliance.