Features of Progress and Treatment of Postprimary Refractory Glaucoma in a Patient with Progressive Mesodermal Iris Atrophy

The problem of degenerative diseases of the vascular tract of the anterior eye`s segment is one of the insufficiently explored in ophthalmology. The relevance of the problem lies in the tactical difficulties in treatment of patients with atypical current secondary glaucoma, that develops as a result of degenerative changes of the eye`s anterior segment. First of all this refers to diseases combined by term thе iridocorneal endothelial syndrome. On the foot of the syndrome is the proliferation of pathologically altered corneal endothelium and its migration as a membrane on the trabecular area of the anterior chamber angle and anterior surface of the iris. This leads to development of secondary angle-closure glaucoma. Purpose. To optimize the approaches to the treatment of secondary decompensated refractory glaucoma on the basis of the clinical case analysis. Patient and methods. A case of bilateral progressivemezodermal atrophy of the iris and the cornea on 49 years old patient, who appealed to the Kirov clinical Ophthalmology hospital in February 2015 year with repeatedly operated decompensated refractory glaucoma. The local status of the patient included: thinning of the front layer of iris, sometimes up to full atrophy with non-through defects and deformation of the pupil, precipitates and spots on the endothelium of the cornea, the anterior peripheral adhesions, membrane-like tissue on the trabecula and the front surface of the iris, glaucoma excavation of the optic disc. Results and discussion. A rare form of corneal endothelial syndrome: essential progressive atrophy of mezodermal of the iris and the cornea has been diagnosed. Pharmacological correction of the intraocular pressure and original drainage surgery was performed. As a result, the patient’s IOP decreased from 38 mm to 16 mm Hg pressure. Conclusions.The unusual nature of secondary glaucoma, according with the progression of essential mezodermal atrophy of iris and cornea caused difficulties in diagnosing and treatment tactics. Correct diagnosis helped to choose the proper individual tactics of combined treatment that allowed to compensate glaucomatous process and save the visual functions for restore an active lifestyle of the patient

Comparison of the Clinical Efficacy of Draining Autovalve Limbosclerectomy and Trabeculectomy in the Treatment of Primary Open-Angle Glaucoma with Long-Term Follow-Up

Purpose: to evaluate the immediate and long-term hypotensive efficacy, the number of complications, and the clinical benefits of a draining autovalve limbosclerectomy (DALS) performed using a kit of disposable instruments in patients with POAG of various stages in comparison with trabeculectomy (TE).Patients and Methods. The study is based on the analysis of the clinical and functional condition of 127 eyes of 127 patients with primary open-angle glaucoma (stage I POAG was detected in 2 eyes, stage II in 30 eyes, stage III in 88 eyes and stage IV in 7 eyes). Patients were divided into groups: the main group—76 people who underwent DALS using a set of disposable instruments, and the control group—51 people who underwent TE. The average age of patients is 68.9 ± 10.3 years. Before and within 24 months after surgery, all patients underwent standard diagnostic examinations. The initial level of IOP against the background of the maximum antihypertensive mode varied from 24 to 50 mm. Hg. According to gonioscopy, the angle of the anterior chamber was open in all cases (III–IV degree). Patient exclusion criteria: history of laser or surgical treatment of glaucoma, cataract treatment.Results. After 24 months of follow-up after DALS, the level of IOP in patients with stage I–II of POAG was 14.19 ± 1.83 mm Hg and with III–IV stage of POAG 14.95 ± 2.15 mm Hg, compensation was achieved in 88.2 % of patients without the use of antihypertensive drops. After TE, compensation was received in 72.6 % of patients, the IOP level was 16.9 ± 2.21 and 17.78 ± 2.31 mm Hg. respectively (p < 0.01). After DALS surgery, a decrease in the number of complications was revealed in comparison with TE: a decrease in сiliochoroidal detachment by 9.1 %, hyphema by 2.5 %, ophthalmic hypertension in the early p/o period by 3.2 %, cystic changes in the filtering bleb by 7.1 %.Conclusion. The standardized DALS operation using a disposable tool kit is a new highly effective and safe method for the surgical treatment of glaucoma. DALS may be the operation of choice in the treatment of POAG of all stages

VERTEBRAL PAIN SYNDROMES IN CHILDREN: ALGORITHMS OF THERAPY DEPENDING ON AGE

Background: Publications on the problem of dorsalgia in children are scarce. Inadequate treatment of back pain in children and adolescents promotes the disease progression and contributes to high prevalence of this syndrome in adult population.Aim: To develop an algorithm of age-dependent treatment of children with dorsalgias based on a multidisciplinary approach and taking into account the stage of the disease.Materials and methods: One hundred and five (105) patients (54 girls and 51 boys) were assessed after admittance to the in-patient department of neurology with complaints on back pain. Chronic pain syndromes (with duration of more than 12 weeks) were noted in 84 (80%) of children, subacute pain syndromes (with 6 to 12 weeks duration), in 8 (7.6%), and acute pain syndromes (of less than 6 weeks duration), in 13 (12.4%). Pain severity and psycho-emotional status were assessed with a visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ). For their treatment, the methods established in neurology were used with consideration of age specifics. The amount and type of medical care depended on the degree of acuity, symptom severity, results of instrumental assessment methods and patient age.Results: The use of combined approach to the treatment of vertebral pain syndromes with special emphasis on non-medical techniques significantly expanded treatment opportunities and improved the results of restorative therapy. Before treatment, moderate and severe pain syndrome (from 4 to 10 on VAS) was seen in 74.3% of patients, whereas after the treatment course, in 22.9% (p < 0.05). Minimal pain intensity (VAS 0–3) was noted at admittance to the hospital in 25.7% of patients and after the course of age-adjusted treatment this percentage increased to 77.1% (p < 0.05). In most cases, the effect of the elaborated treatment complex was seen up to 12 months, and if some maintenance treatment courses were performed, up to 2–4 years and more. During the follow- up that lasted from 6 to 48 months, 30.8% of patients was hospitalized again; however, in all of them the pain syndrome was significantly less severe (VAS 1–6) than at primary admittance.Conclusion: Implementation of treatment algorithms, that are commonly used in adult practice and are adapted to pediatric age, allows for a significant decrease in severity of the pain syndrome or for its complete elimination, for improvement of affective disorders (p < 0.0001) and reduction of relapse risks, as well as for maintenance of social and daily adaptation of patients