Бринзоламид/тимолол и латанопрост в лечении псевдоэксфолиативной глаукомы: сравнительное исследование

PURPOSE: To compare the long-term effectiveness of pseudoexfoliative glaucoma (PEG) treatment with a fixed combination (FC) brinzolamide/timolol vs. latanoprost by a comprehensive assessment of structural and functional changes, as well as indicators of arterial ocular blood flow. METHODS: We observed 42 patients with PEG who received FC brinzolamide/timolol (22 patients) 2 times daily or latanoprost once a day (20 patients). The groups were homogeneous for age (66.05±1.241 in brinzolamide/ timolol group and 63.8±2.09 in latanoprost group, p=0.36) and glaucoma stages (MD -6.43±1.51 dB in brinzolamide/ timolol group and -8.02±2.08 dB in latanoprost group, p=0.54), intraocular pressure (IOP) levels were also comparable (19.59±0.79 mm Hg in brinzolamide/timolol group and 19.94±0.88 mm Hg in latanoprost group, p=0.77). The functional and morphometric parameters, studied by means of standard automated perimetry and spectral optical coherence tomography, and ocular blood flow parameters, measured by color Doppler Imaging with impulse Doppler sonography, were subjected to a comparative evaluation. Follow up period was 10.5±0.363 month. RESULTS: A significant IOP reduction, compared with baseline was observed in both groups: 11% from baseline in brinzolamide/timolol group (p=0.005) and 12.5% from baseline in latanoprost group (p=0.011). MD was improved in brinzolamide/timolol group: by 1.2±0.37 dB (p=0.003). No statistically significant difference in RNFL, GlV and GCC was obtained in both groups during the follow up period. However, by the end of 12 months a significant increase of FLV was noted in latanoprost group (p=0.04). By the end of the observation period patients treated with brinzol-amide/timolol showed an increase in diastolic blood flow in the ophthalmic artery (p=0.044) and systolic blood flow in the lateral posterior short ciliary artery (p=0.011). CONCLUSION: FC brinzolamide/timolol and latanoprost demonstrate a significant hypotensive efficacy in PEG, however FC brinzolamide/timolol unlike latanoprost provides stabilization of glaucomatous optic neuropathy, as evidenced by the preservation of visual function and morpho-metric parameters of the retina and optic nerve, as well as an improved arterial ocular blood flow.ЦЕЛЬ. Сравнить долгосрочную эффективность лечения псевдоэксфолиативной глаукомы (ПЭГ) фиксированной комбинацией бринзоламид/тимолол (ФК бринзоламид/ тимолол) с латанопростом на основании комплексной оценки структурных и функциональных изменений, а также показателей артериального глазного кровотока. МЕТОДЫ. В исследовании приняли участие 42 пациента с ПЭГ, получавшие ФК бринзоламид/тимолол (22 больных) 2 раза в день или латанопрост 1 раз в день (20 больных). Группы были однородны по возрасту (66,05±1,24 года в группе, получавшей ФК бринзоламид/тимолол, и 63,8±2,09 года в группе, получавшей латанопрост, р=0,36), по стадиям глаукомы (MD -6,43±1,51 дБ в группе ФК бринзоламид/тимолол и -8,027±2,08 дБ в группе латанопрост, р=0,54), а также по исходному уровню внутриглазного давления (19,59±0,79 и 19,94±0,88 мм рт.ст. соответственно в группах ФК бринзоламид/тимолол и латанопрост, р=0,77). Сравнительной оценке подвергнуты функциональные и морфометрические показатели, полученные при стандартной автоматизированной периметрии и спектральной оптической когерентной томографии, а также параметры регионарной гемодинамики глаза, измеренные в динамике методом цветового доп-плеровского картирования с импульсной допплерогра-фией. Средний срок наблюдения составил 10,5±0,36 мес. РЕЗУЛЬТАТЫ. В обеих группах больных наблюдалось достоверное по сравнению с исходным снижение ВГД, которое составило в группе ФК бринзоламид/тимолол 11% от исходного (p=0,005) и в группе латанопрост 12,5% от исходного (p=0,011). Было отмечено улучшение периметрического индекса MD у больных, получавших ФК бринзоламид/тимолол, на 1,2±0,37 дБ по сравнению с исходным (p=0,003). Статистически значимого изменения морфометрических показателей в динамике не было отмечено ни в одной группе, за исключением достоверного увеличения индекса FLV (p=0,04) у больных, получавших латанопрост. У пациентов, лечившихся ФК бринзоламид/тимолол, к концу наблюдения отмечено увеличение диастолической скорости кровотока в глазной артерии (p=0,044) и систолической скорости кровотока в латеральной задней короткой цилиарной артерии (p=0,011). ЗАКЛЮЧЕНИЕ. ФК бринзоламид/тимолол и латанопрост обладают выраженной гипотензивной эффективностью в лечении ПЭГ, однако ФК бринзоламид/тимолол, но не латанопрост, обеспечивает стабилизацию глаукомной оптической нейропатии, о чем свидетельствует сохранение зрительных функций и морфометрических характеристик сетчатки и зрительного нерва, а также улучшение артериального глазного кровотока

The study of morphological changes and regional hemodynamics in pseudoexfoliative glaucoma

Aim. Comparative study of choroidea, retina ganglion cell complex (GCC) and regional hemodynamics in primary open angle (POAG) and pseudoexfoliative glaucoma (PEG) patients.Materials and methods. 40 POAG patients and 36 PEG patients with the same disease stage were observed. MD –1.52±0.27 in POAG group and –2.38±0.35 in PEG group (p = 0. 069). Subjects were age-matched (ranged from 60 to 70 years: 69.41±1.207 66.32±0.75 in PEG group;p = 0.32) and comparable for axial eye length (24.08±0.38 in POAG group, 23.48±0.27 in PEG group; p = 0.208).Results. Significant difference in focal loss of retinal ganglion cells (FLV) between POAG and PEG groups was revealed (1.875±0.399 and 3.535±0.684, respectively; p = 0.035). Choroidea thickness decrease was discovered in PEG patients as compared with POAG patients: 219.55±17.81 and 266.93±15.9, respectively, at the fovea (p = 0.048);and 117.1±10.1 and 158.3±14.8, respectively, at the peripapillary area (p = 0.026). The reduction of blood flow velocity in ophthalmic artery (29.08±2.38 cm / sec), central retinal vein (5.22±0.29 cm / sec) and superior ophthalmic vein (5.22±0.29 cm / sec) were observed in PEG group as compared with POAG group (34.10±1.47, 7.54±0.53 and6.47±0.33 cm / sec, respectively). The significance of these differences is confirmed by the following data: p = 0.05 (for Vsyst in ophthalmic artery), р = 0.012 (for Vsyst in central retinal vein) and p = 0.007 (for Vmean in superior ophthalmic vein).Conclusion. At the same disease stage, PEG is characterized by greater choroidea thinning, GCC damage and reduced blood flow in large retrobulbar vessels as compared with POAG

Flammer syndrome.

The new term Flammer syndrome describes a phenotype characterized by the presence of primary vascular dysregulation together with a cluster of symptoms and signs that may occur in healthy people as well as people with disease. Typically, the blood vessels of the subjects with Flammer syndrome react differently to a number of stimuli, such as cold and physical or emotional stress. Nearly all organs, particularly the eye, can be involved. Although the syndrome has some advantages, such as protection against the development of atherosclerosis, Flammer syndrome also contributes to certain diseases, such as normal tension glaucoma. The syndrome occurs more often in women than in men, in slender people than in obese subjects, in people with indoor rather than outdoor jobs, and in academics than in blue collar workers. Affected subjects tend to have cold extremities, low blood pressure, prolonged sleep onset time, shifted circadian rhythm, reduced feeling of thirst, altered drug sensitivity, and increased general sensitivity, including pain sensitivity. The plasma level of endothelin-1 is slightly increased, and the gene expression in lymphocytes is changed. In the eye, the retinal vessels are stiffer and their spatial variability larger; the autoregulation of ocular blood flow is decreased. Glaucoma patients with Flammer syndrome have an increased frequency of the following: optic disc hemorrhages, activated retinal astrocytes, elevated retinal venous pressure, optic nerve compartmentalization, fluctuating diffuse visual field defects, and elevated oxidative stress. Further research should lead to a more concise definition, a precise diagnosis, and tools for recognizing people at risk. This may ultimately lead to more efficient and more personalized treatment