Prospective, randomized study of one, two, or three trabecular bypass stents in open-angle glaucoma subjects on topical hypotensive medication

PURPOSE: To assess the safety and efficacy of one, two, or three trabecular microbypass stents in eyes with primary open-angle glaucoma (OAG) not controlled on ocular hypotensive medication. A total of 119 subjects were followed for 18 months postoperatively. MATERIALS AND METHODS: Subjects with medicated intraocular pressure (IOP) 18–30 mmHg and postmedication-washout baseline IOP 22–38 mmHg were randomized to implantation of one, two, or three stents. Ocular hypotensive medication was to be used if postoperative IOP exceeded 18 mmHg. RESULTS: A total of 38 subjects were implanted with one stent, 41 subjects with two stents, and 40 subjects with three stents. Both month 12 IOP reduction ≥20% without ocular hypotensive medication vs baseline unmedicated IOP and month 12 unmedicated IOP ≤18 mmHg were achieved by 89.2%, 90.2%, and 92.1% of one-, two-, and three-stent eyes, respectively. Furthermore, 64.9%, 85.4%, and 92.1% of the three respective groups achieved unmedicated IOP ≤15 mmHg. Over the 18-month follow-up period, medication was required in seven one-stent subjects, four two-stent subjects, and three three-stent subjects. At 18 months, mean unmedicated IOP was 15.9±0.9 mmHg in one-stent subjects, 14.1±1.0 mmHg in two-stent subjects, and 12.2±1.1 mmHg in three-stent subjects. Month 18 IOP reduction was significantly greater (P<0.001) with implantation of each additional stent, with mean differences in reduction of 1.84 mmHg (95% confidence interval 0.96–2.73) for three-stent vs two-stent groups and 1.73 mmHg (95% confidence interval 0.83–2.64) for two-stent vs one-stent groups. Adverse events through 18 months were limited to cataract progression with best-corrected visual acuity loss and subsequent cataract surgery. CONCLUSION: In this series, implantation of each additional stent resulted in significantly greater IOP reduction with reduced medication use. Titratability of stents as a sole procedure was shown to be effective and safe, with sustained effect through 18 months postoperatively in OAG not controlled with medication

S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system

Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment

Синдром Фламмера

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.Нововведеный термин «синдром Фламмера» описывает фенотип, характеризующийся наличием первичной сосудистой дисрегуляции вместе с комплексом симптомов и признаков, которые могут возникать как в норме, так и при патологии. Как правило, кровеносные сосуды больных с синдромом Фламмера по-разному реагируют на ряд раздражителей, таких как холод и физический или эмоциональный стресс. В данный синдром могут быть вовлечены почти все органы, в том числе орган зрения. Наличие синдрома Фламмера предполагает некоторые положительные стороны, например, защиту против атеросклероза. С другой стороны, синдром Фламмера способствует развитию ряда заболеваний, в том числе глаукомы нормального давления. Синдром чаще встречается у женщин, чем у мужчин, у стройных людей, чем у тучных субъектов, у лиц интеллектуальных профессий. Страдающие данным синдромом, как правило, имеют холодные конечности, низкое артериальное давление, бессонницу, нарушенный циркадианный ритм, сниженное чувство жажды, измененную чувствительность к лекарственным препаратам, а также повышенную общую чувствительность, в том числе болевую. У них увеличен плазменный уровень эндотелина-1 и изменена экспрессия генов в лимфоцитах. Ретинальные сосуды становятся жестче, изменяется их пространственная конфигурация, а также снижается саморегуляция глазного кровотока. Отмечается повышение риска возникновения глаукомы: возникают кровоизлияния на диске зрительного нерва, активируются астроциты и повышается давление в ретинальных венах, могут появиться симптомы сдавления зрительного нерва и отмечаются диффузные дефекты поля зрения. Все эти явления развиваются на фоне оксидантного стресса. Целью дальнейших исследований является поиск диагностических критериев заболевания и инструментальных методов выявления группы риска по данной нозологии. Это позволит индивидуализировать лечение и повысить его эффективность

[Avian cytogenetics goes functional] Third report on chicken genes and chromosomes 2015

High-density gridded libraries of large-insert clones using bacterial artificial chromosome (BAC) and other vectors are essential tools for genetic and genomic research in chicken and other avian species... Taken together, these studies demonstrate that applications of large-insert clones and BAC libraries derived from birds are, and will continue to be, effective tools to aid high-throughput and state-of-the-art genomic efforts and the important biological insight that arises from them

Glaucoma and Arterial Hypertension

Arterial hypertension occurs in 48-65 % patients with primary open-angle glaucoma. It is the most frequent systemic disease among these patients. On the other hand, it is an independent risk factor for primary open-angle glaucoma which must be taken into consideration in the development of the glaucoma treatment strategy. The low influence on the intraocular pressure and the significant perfusion disturbances cause damages to the whole visual system, which in its turn exacerbates the detrimental effects of the intraocular pressure elevation on the glaucomatous optic neuropathy. It is necessary to keep blood pressure at a normal level and to avoid the absence of night-time blood pressure dipping or extreme dipping, as the hypotensive phases impair the autoregulation of papillary blood flow, which finally leads to the emergence of ischemic areas. Intraocular pressure reduction is only one of the aspects of the antiglaucomatous therapy, since it does not prevent the progression of glaucomatous optic neuropathy. In this case, intensive interaction of various medical disciplines is required for the long-term stabilization of the glaucoma process // Russian Ophthalmological Journal, 2016; 1: 105-111

Short wavelength automated perimetry, frequency doubling technology perimetry, and pattern electroretinography for prediction of progressive glaucomatous standard visual field defects. Ophthalmology 109:10091017

Purpose: To evaluate the clinical use of a test battery of short wavelength automated perimetry (SWAP), frequency doubling technology perimetry (FDT), and pattern electroretinography (PERG) in predicting progressive glaucomatous visual field defects on standard automated perimetry (SAP). Study Design: A prospective, longitudinal, observational case series. Participants: One hundred and fifty-two patients with primary open-angle glaucoma (POAG) with bilateral glaucomatous visual field defects on SAP were followed at 6-month intervals over a period of 30 months. Main Outcome Measures: Short wavelength automated perimetry, FDT, and PERG results were compared between POAG eyes with and without progressive field loss on SAP. These two groups were used to evaluate whether PERG, SWAP, and/or FDT is predictive of future progression of field loss on SAP. Results: Using the criteria of progressive field loss on SAP defined by the Collaborative Normal Tension Glaucoma Study, 54 eyes (study group) of 54 POAG patients showed progressive defects, whereas 84 eyes (control group) of 84 POAG patients showed no progression. Only 11.1 % (6 of 54) of the eyes with a progression of field loss on SAP showed no increase of deficits on the three functional tests before progression. Short wavelength automated perimetry detected early progressive defects on SAP in 43 of the 54 eyes (79.6%). Of these 54 POAG eyes, FDT showed progressive deficits in 40 eyes (74.1%), whereas PERG amplitude P1N