A modern view of cyclodestructive surgery for glaucoma

The main purpose of glaucoma treatment is to reduce the intraocular pressure (IOP) to a target level. One of the pathogenetically justified method of treatment for various types of glaucoma, first of all its refractory forms, is the surgery on the ciliary body. A purpose of such manipulations is to suppress excessive formation of aqueous humor. Previously, diode laser cyclophotocoagulation was widely used, which is mainly applied in terminal glaucoma. Technological innovations have led to the development of perspective, more safe, and less destructive methods of cyclodestructive anti-glaucomatous operations, such as micro-pulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation, and ultrasound cyclodestruction. During micro-pulse cyclophotocoagulation, the effect of laser energy occurs by short pulses at rest intervals, which significantly reduces the absorption of energy by surrounding tissues and their associated damage. With endoscopic cyclophotocoagulation, the epithelium of the ciliary processes is directly coagulated, which makes it possible to dose laser energy under visual control. Ultrasonic cyclodestruction causes a coagulation necrosis of the ciliary processes with a very insignificant collateral damage of surrounding tissues. Today these surgical techniques are becoming more relevant in the treatment of refractory glaucoma in order to preserve visual functions. This review is an analysis of modern literature, reflecting the efficacy and safety of cyclodestructive operations with sufficiently high visual functions

Показатели офтальмотонометрии в здоровой популяции

Intraocular pressure (IOP) is the main risk factor of glaucoma development and progression. Glaucoma screening is mostly based on performing ocular tonometry — the most frequent procedure in patient examination. Clinical practice uses tonometry values that are closely connected to ocular pressure but may differ significantly in absolute values, which is why normative bases of various tonometry devices differ.Values obtained with Maklakoff and Goldmann tonometers, non-contact tonometry devices and bidirectional applanation tonometry have a practical importance. Data provided by Maklakoff tonometry establishes a mean tonometry value in healthy population at 20 mm Hg with a standard deviation of 2.5-3.0 mm Hg. Most populationbased studies are conducted with the use of Goldmann tonometer.Its mean tonometry values vary according to different authors, but most prevalently denominated level is 16 mm Hg with a standard deviation of 2-3 mm Hg. Noncontact tonometers generally show a lower by 2-3 mm Hg IOP level and a higher range of standard deviation (3-5 mm Hg). Corneal compensated IOP values normally have an allocation similar to Goldmann tonometry, which can be explained by specifics of calibration and measurement model development. Its men value in healthy population is 16 mm Hg with a standard deviation of 2.5 mm Hg. It should also be noted that corneal compensated IOP has less variation in value distribution.Thus a question of normal IOP values and tonometric measurements is much more complex than is considered to be the case in modern ophthalmology. Intraocular pressure examination in the context of population diversity aggravated by iatrogenic factors should be conducted by adequate means implementing personalized approach.Внутриглазное давление (ВГД) является основным фактором риска развития и прогрессирования глаукомы. Скрининг на глаукому основан в первую очередь на офтальмотонометрических измерениях, и это самая часто повторяемая процедура при обследовании пациентов. В клинической практике для оценки ВГД используют показатели тонометрии, которые тесно связаны с офтальмотонусом, но могут существенно отличаться по абсолютной величине, поэтому нормативы зависят от прибора, применяемого для измерения.Практически важными являются значения показателей тонометрии в здоровой популяции, определяемые с помощью тонометров Маклакова, Гольдмана, бесконтактных приборов и метода двунаправленной пневмоаппланации роговицы. Исследования, выполненные с использованием тонометра Маклакова, указывают на среднее значение показателя тонометрии в здоровой популяции, равное 20 мм рт.ст. Стандартное отклонение результатов составило в работах 2,5-3 мм рт.ст. Наибольшее количество популяционных исследований офтальмотонуса проведено с помощью тонометра Гольдмана. Средние значения показателя тонометрии для этого прибора в здоровой популяции, по данным авторов, различны, но наиболее частое значение ‒ 16 мм рт.ст. со стандартным отклонением от 2 до 3 мм рт.ст. Бесконтактные тонометры в большинстве исследований показывают более низкие значения офтальмотонуса, в среднем на 2-3 мм рт.ст., с большим разнообразием результатов, проявляющемся в стандартном отклонении 3-5 мм рт.ст. Нормальные значения роговично-компенсированного ВГД (IOPcc) распределены аналогично показателю тонометрии по Гольдману, что связано с особенностями калибровки и создания модели измерения. Среднее значение IOPcc в здоровой популяции равно 16 мм рт.ст. со стандартным отклонением около 2,5 мм рт.ст. Стоит отметить, что распределение значений роговично-компенсированного ВГД является более равномерным.Таким образом, вопрос нормы ВГД и результатов офтальмотонометрических исследований является более сложным, чем принято в современной офтальмологии.Исследование ВГД в условиях природного популяционного разнообразия, усугубляемого ятрогенными факторами, должно проводиться с помощью методов, реализующих персонифицированный подход

A long-term period of observation a patients with moderate and advanced open-angle glaucoma after implantation glau- coma device Ex-PRESS

Purpose: to determine the long-term efficiency and safety of implantation Ex-PRESS open-angle glaucoma device to patients at advanced stage of POAG.Methods: Seven male patients underwent penetrating filtering surgery with implantation of the Ex-PRESS shunt over the lack of stabilization of visual functions on hypotensive drugs.Results: Average monitoring of patients was 19.96±9.73 months. IOP in postoperative period was 16.14±3.67 mm Hg (by Makla- kov). the reduction of IOP was 12.72 mm Hg (40.2%). Cell density didn’t differ from double (2879±87 cell/mm2 и 2798±67 cell/mm2, p&gt;0.05).Conclusion: Long-term gradual reduction of IOP and safety of implantation Ex-PRESS glaucoma device may be a reason of choicethis type of surgery for patients at advanced stage.</p

Arterial hypertension with stroke risk: clinical features, circadian blood pressure profiles, angiotensin II antagonist treatment

Aim. To investigate arterial hypertension (AH) clinical features in patients who suffered stroke (S) in previous 12 months. Material and methods. Prevalence of various risk factors (RF), target organ damage and associated pathology, was compared in two groups: Group I – 500 S-free AH patients, mean age 64.8±6.2 years; Group II - 467 AH patients with S, mean age 66.2±4.3 years. 24-hour blood pressure monitoring, brachiocephalic artery duplex scanning, and echocardiography were preformed in all participants. Results. In pre-S period, a syndrome of “poor prognosis” could be identified, that included some clinical and instrumental symptoms of aggressive RF influence and cardiovascular remodeling. In AH patients with high S risk, circadian BP profiles were disturbed, with increased prevalence of non-dippers, over-dippers, and night-peakers. Conclusion. Long-term antihypertensive therapy with eprosartan in AH patients with or without S, demonstrated multiple beneficial effects: target BP level achievement, and circadian BP profile normalization