Клинико-фармакологические аспекты сочетанной патологии: сердечно-сосудистые заболевания и глаукома

The review presents clinical and pharmacological aspects of treating glaucoma patients with cardiovascular diseases and current epidemiology of cardiovascular diseases in Russian Federation. It discusses the most widespread cardiovascular diseases and medications for their treatment (organic nitrates, systemic beta-blockers etc.). The article describes the effects of anti-glaucoma medications (beta-blockers, alpha2-adrenoceptor agonists, prostaglandins, carbonic anhydrase inhibitors) on cardiovascular system (heart rate, blood pressure) and the course of treatment of cardiovascular diseases, including cardiovascular mortality. Authors enumerate the main absolute and relative contraindications to different groups of anti-glaucoma medications: prominent forms of cardiovascular pathology (atrioventricular block II-III degree, decompensation of chronic heart failure, marked bradycardia). The impact of the medications for cardiovascular diseases (antihypertensive drugs, organic nitrates, antiplatelet medications) on intraocular pressure and the course of glaucoma is also described in the review. It emphasizes the necessity of developing a rational systemic antihypertensive regimen to avoid the episodes of nocturnal arterial hypotension that promote the progression of glaucoma. The article also presents examples of possible clinically significant drug-drug interactions in patients with combined pathology. The authors provide recommendations on improving treatment efficiency and pharmacotherapeutic safety in patients with glaucoma in combination with cardiovascular diseases.В обзоре представлены клинико-фармакологические аспекты ведения пациентов с глаукомой в сочетании с сердечно-сосудистыми заболеваниями, эпидемиология сердечно-сосудистых заболеваний в РФ. Обсуждаются наиболее распространенные сердечно-сосудистые заболевания и лекарственные препараты для их лечения (органические нитраты, системные бета-адреноблокаторы и т.д.). Описано влияние противоглаукомных препаратов (бета-адреноблокаторов, альфа2-адреномиметиков, простагландинов, ингибиторов карбоангидразы) на сердечно-сосудистую систему (частоту сердечных сокращений, артериальное давление) и течение сердечно-сосудистых заболеваний, включая сердечно-сосудистую смертность. Авторы представляют абсолютные и относительные противопоказания к применения различных групп противоглаукомных препаратов: выраженные формы сердечно-сосудистой патологии (атриовентрикулярная блокада II-III степени, декомпенсация хронической сердечной недостаточности, выраженная брадикардия). Также отражено влияние препаратов, применяемых при сердечнососудистых заболеваниях (антигипертензивные препараты, органические нитраты, антиагреганты), на внутриглазное давление и течение глаукомы. Подчеркивается важность коррекции системной антигипертензивной терапии для того, чтобы избежать ночных эпизодов системной гипотонии, способствующей прогрессированию глаукомы. Приводятся примеры возможных клинически значимых фармакокинетических и фармакодинамических взаимодействий лекарственных препаратов у пациентов с сочетанной патологией. Авторы дают рекомендации по повышению эффективности и безопасности фармакотерапии пациентов с глаукомой в сочетании с сердечно-сосудистыми заболеваниями

ТРАВМА ОРБИТЫ: СУДЕБНО-МЕДИЦИНСКАЯ ОЦЕНКА ЕЕ ИСХОДОВ

Functional assessment of visual system in orbital traumas is very important both for practical treatment and in further forensic medical examination of victims. The aim of our clinical studies was to reason the differentiated approach in determining the severity of harm to the health in case of orbital trauma combined with mild craniocerebral injury. Thirty-four patients with orbital trauma have been studied within a period of 3 weeks — 2.5 months after the injury. A comprehensive check of the ophthalmologic status as performed including standard and precise methods of testing the retina and the optic nerve. An overall examination allowed to exclude eye disorders in patients with orbital trauma combined with mild craniocerebral injury, which provided an objective approach in determining the severity of harm caused to the health.Оценка функционального состояния зрительного анализатора при травмах орбиты весьма важна как для практической врачебной работы, так и для последующей судебно-медицинской экспертизы пострадавших. Клинические исследования были проведены с целью обоснования дифференцированного подхода к квалификации степени вреда здоровью при травме орбиты в сочетании с черепно-мозговой травмой (ЧМТ) легкой степени тяжести. Обследованы 34 пациента с травмой орбиты в сроки от 3 нед до 2,5 мес после травмы, проведена комплексная оценка офтальмологического статуса с использованием стандартных и высокоточных методов оценки состояния сетчатки и зрительного нерва. Комплексное обследование пациентов позволило исключить наличие патологии органа зрения при травме орбиты, сочетанной с ЧМТ легкой степени тяжести, что должно обеспечить объективный подход в квалификации степени тяжести вреда здоровью

ОСОБЕННОСТИ СОСТОЯНИЯ ОРГАНА ЗРЕНИЯ У ПАЦИЕНТОВ ПОСЛЕ ТРАНСПЛАНТАЦИИ ПОЧКИ

Structural changes in eyes are present in all patients with chronic kidney disease. A study to detect ocular patho- logy in patients with end-stage chronic renal failure after kidney transplantation in the early and late postopera- tive period compared with patients receiving replacement therapy with hemodialysis. Revealed that in the early post-transplant period in recipients of kidneyas in patients on hemodialysis, continued angioretinopatiya, 40% of patients had «dry eye syndrome». In the delayed post-transplant period, patients showed significant impro- vement in the retina and retinal vessels, the improvement of spatial-temporal parameters of visual perception. However, a decrease of visual acuity on the background of the development of posterior subcapsular cataract caused by prolonged corticosteroid, and an increased incidence of viral and bacterial conjunctivitis. Структурные изменения органа зрения имеются у всех больных с хронической болезнью почек. Проведе- но исследование для выявления глазной патологии у больных с терминальной стадией ХПН после транс- плантации почки в раннем и отдаленном периоде в сравнении с пациентами, получающими заместитель- ную терапию гемодиализом. Выявлено, что в раннем посттрансплантационном периоде у реципиентов ПАТ, как и у пациентов на гемодиализе, сохранялась ангиоретинопатия, у 40% пациентов отмечался син- дром «сухого глаза». В отсроченном посттрансплантационном периоде у пациентов выявлено значимое улучшение состояния сетчатки и ретинальных сосудов, улучшение пространственно-временных показа- телей зрительного восприятия. Однако отмечалось снижение остроты зрения на фоне развития задней субкапсулярной катаракты, обусловленной длительным приемом кортикостероидов, и увеличение часто- ты вирусных и бактериальных конъюнктивитов.

Cataract prevalence and prevention in Europe: a literature review

This literature review is aimed at the evaluation of the potential for cataract prevention in Europe. It was performed using Pub-MED with Mesh and free text terms. Studies included were: a) performed on a population of Caucasian origin at an age range of 40-95 years, b) cataract was clinically verified, c) drug record of prescriptions, their indication, a record of every diagnosis, dosage, and quantity of prescribed medicine were available, d) sample size >300, e) published between 1990 and 2009. The results of 29 articles were reviewed. Former (3.75 [2.26-6.21]) or current smoking (2.34 [1.07-5.15]), diabetes of duration >10 years (2.72 [1.72-4.28]), asthma or chronic bronchitis (2.04 [1.04-3.81]), and cardiovascular disease (1.96 [1.22-3.14]) increased the risk of cataract. Cataract was more common in patients taking chlorpromazine during >90 days with a dosage >300 mg, corticosteroids used >5 years (3.25 [1.39-7.58]) in a daily dose >1600 mg (1.69 [1.17-2.43]), a multivitamin/mineral formulation (2.00 [1.35-2.98]) or corticosteroids (2.12 [1.93-2.33]). Corticosteroid applied orally (3.25 [1.39-7.58]), parenteral (1.56 [1.34-1.82]) or inhalational (1.58 [1.46-1.71]) lead to cataract more frequently than those applied topically: nasal (1.33 [1.21-1.45]), ear (1.31 [1.19-1.45]), or skin (1.43 [1.36-1.50]). Outpatient cataract surgery was negatively associated with total cataract surgery costs, and chlorpromazine, corticosteroids, and multivitamin/mineral formation increase the risk of posterior sub-capsular cataract dependent on dose, treatment application, and duration. This review presented a comprehensive overview of specific and general cataract risk factors and an update on most recent experimental studies and randomized control trials directed at cataract prevention

Modern Aspects of Hypertensive Angioretinopathy

This literature review is devoted to modern problems of hypertensive retinopathy with arterial hypertension, as well as hypertensive retinopathy in combination diseases. The latest world studies were analyzed. Particular attention is paid to the clinical disease characteristics at the present stage with the analysis of the arterio-venous ratio, optic nerve edema (with high blood pressure figures) using an automated system, vector analysis, suggesting a new arteriovenous classification, called Web Integration (Wivern). The modern pathogenesis of hypertensive retinopathy, namely the ratio of proangiogenic and anti-angiogenic factors, the role of inflammation (C-reactive protein), the role of endothelin-1, endostatin, interleukin-8 (IL-8), and the main fibroblast growth factor (bFGF ), angiogenin and uric acid. The special importance of fundus registration is reflected with the help of the newest equipment at high figures of arterial pressure in patients with hypertensive retinopathy. It is known that according to the World Health Organization (WHO), mortality rate from cardiovascular diseases is 31 %. Hypertension is the main risk factor for coronary heart disease, myocardial infarction, heart failure, stroke, kidney disease and early death. Questions of eye blood flow in hypertensive angioretinopathy in patients with arterial hypertension (AH) are covered. Hypertensive retinopathy (HR) is a retinal disease that is caused by a prolonged increase blood pressure (BP) and leads to a decrease in vision. The data of pathophysiology are analyzed (arterial hypertension (AH) leads to thickening of the vessels of the inner membrane (intima), to thickening of the medial membrane (media) — hyperplasia of the muscular tissue followed by hyaline degeneration with the development of sclerotic changes). The questions of modern diagnostics with retinal morphological status evaluation (OCT), detection of eye fundus condition with newest fundus camers, pathogenetic aspects are discussed. This review will help to prevent the development of more severe forms of hypertensive retinopathy. This information will allow us to identify the most significant indicators in the early diagnosis of hypertension angioretinopathy

Epidemiology of retinal vein occlusions: state-of-the-art

L.К. Moshetova1, S.А. Usharova1, S.V. Simonova1,2, К.I. Turkina1 1Russian Medical Academy of Continuous Professional Education, Moscow, &nbsp;Russian Federation 2Research Institute of Public Health Organization and Medical Management, &nbsp;Moscow, Russian Federation Impaired blood flow in various organs and tissues is a common cause of disabling disorders that even result in a lethal outcome. Despite an extremely rapid development of modern medicine, the rate of these disorders is still high thus emphasizing the importance of further detailed studies on this issue. In addition to systemic vascular diseases, local blood flow disturbances are also prevalent among population. These disturbances result from more significant blood flow disorders. Retinal vein occlusion is not an exclusion. Acute retinal vein occlusions account for more than half of ocular vascular diseases and may lead to extremely severe ophthalmic complications that result in poor vision, blindness, and reduced quality of life in both young and elderly patients. The diversity of clinical presentations, their severity, and clinical course make the diagnosis challenging thus altering the assessment of the prevalence of these diseases. Keywords: retinal vein occlusion, epidemiology, systemic vascular disorders, risk factors, retinal vessels. For citation: Moshetova L.К., Usharova S.А., Simonova S.V.,Turkina К.I. Epidemiology of retinal vein occlusions: state-of-the-art. Russian Journal of Clinical Ophthalmology. 2021;21(2):–89. DOI: 10.32364/2311-7729-2021-21-2-86-89. <br

Stem cells for age-related macular degeneration

L.K.&nbsp;Moshetova1, O.I.&nbsp;Abramova1, I.N.&nbsp;Saburina2,3, K.I.&nbsp;Turkina2 1Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation 2Institute for Molecular and Personalized Medicine, branch of Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation 3Institute of General Pathology and Pathophysiology, Moscow, Russian Federation Unique biological properties of stem cells offer infinite opportunities to use them for numerous degenerative disorders. Thus, in ophthalmology cell replacement therapy is a prospective approach to manage irreversible retinal cell death in age-related macular degeneration. Currently, this disorder is the leading cause of disability, blindness, and reduced quality of life in people aged over 50 in developed countries and is therefore important medical social issue. None of current treatment approaches can either turn back or prevent pre-existing retinal cell degeneration. Therefore, cell replacement therapy and regenerative medicine are promising modalities since they are characterized by much greater prospects than traditional treatment. This paper reviews recent advantages in the treatment for this incurable disorder using various types of stem cells (i.e., mesenchymal, embryonic, and induced pluripotent stem cells). This paper first gives a brief overview of age-related macu lar degeneration and then describes the methods of retinal cell generation. Keywords: age-related macular degeneration, stem cells, eye tissue regeneration, pluripotent stem cells, clinical application of stem cells, regenerative medicine, cell therapy, tissue engineering. For citation: Moshetova L.K., Abramova O.I., Saburina I.N., Turkina K.I. Stem cells for age-related macular degeneration. Russian Journal of Clinical Ophthalmology. 2019;19(3):143–148. About the authors: 1Larisa&nbsp;K.&nbsp;Moshetova — MD, PhD, Academician of RAS, Head of the Department of Ophthalmology, ORCID iD: 0000-0002-5899-2714; 1Olga&nbsp;I.&nbsp;Abramova — MD, postgraduate student of the Department of Ophthalmology, ORCID iD 0000-0002-6156-6126; 2,3Irina&nbsp;N.&nbsp;Saburina — PhD, Professor, Principal Researcher, Head of Laboratory, ORCID iD 0000-0003-2014-2535; 1Kseniya&nbsp;I.&nbsp;Turkina — MD, PhD, associate professor of the Department of Ophthalmology, ORCID iD 0000-0002-4989-7467. 1Russian Medical Academy of Continuous Professional Education. 2/1, Barrikadnaya Str., Moscow, 125993, Russian Federation. 2Institute for Molecular and Personalized Medicine. 7, Build. 2, 2nd&nbsp;Botkinskiy Pass., Moscow, 125284, Russian Federation. 3Institute of General Pathology and Pathophysiology.&nbsp; 8, Baltijskaya Str., Moscow, 125315, Russian Federation. Contact information:&nbsp;Olga&nbsp;I.&nbsp;Abramova, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no author has a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;17.07.2019. <br

Retinal status in moderate myopia and age-related macular degeneration. Management strategies

L.K. Moshetova1, I.B. Alekseev1–3, I.V. Vorob’eva1,2, Yu.A. Nam3 1Russian Medical Academy of Continuous Professional Education, Moscow, &nbsp;Russian Federation 2S.P. Botkin City Clinical Hospital, Moscow, Russian Federation 3Treatment Rehabilitation Center of the Ministry of Economic Development, Moscow, &nbsp;Russian Federation Aim: to assess retinal status in comorbid ocular disorders (moderate myopia and age-related macular degeneration/AMD of various stages) using modern diagnostic tools. Patients and Methods: 48 patients (96 eyes) with moderate myopia and dry AMD were enrolled. Best-corrected visual acuity (BCVA), mean deviation/MD (characterizes mean reduction of sensitivity), pattern standard deviation/PSD (characterizes the severity of local visual field defects), central macular thickness (CMT), and axial length (AL) were measured. The macular zone was investigated by optical coherence tomography (OCT) using B scan and fundus autofluorescence (FAF) regimens. Results: in moderate myopia associated with dry AMD (AREDS categories 1,2,3), a significant reduction in the mean BCVA (20/25) was detected in 54.2% (26 patients, 52 eyes). Retinal photosensitivity indices (MD and PSD) were also significantly reduced to 2.19 dB (р&lt;0.001) and 2.14 dB (р&lt;0.001), respectively. AL was significantly increased (25.11 mm, р&lt;0.001). No significant differences in CMT values were revealed (233 mcm, p=0.123). In comorbid ocular disorders, severe defects and focuses of RPE atrophy, extensive areas of the IS/OS junction line damage, and drusen are seen among morphological abnormalities of the eye fundus. FAF identified certain pathological patterns, e.g., focal hypo- and hyperautofluorescence, hyperautofluorescent halo at the border of staphyloma, linear hypoautofluorescent bands surrounded with hyperautofluorescence, reticular pattern, patches, focal and multifocal areas of geographic atrophy. Conclusion: our findings on visual field loss (MD, PSD) in AMD depending on stage and OCT findings in AMD are in line with the results of other authors. Meanwhile, we investigated a comorbid variant (AMD in association with moderate myopia), compared morphological and functional parameters, and addressed the relevance of FAF. Keywords: myopia, age-related macular degeneration, optical coherence tomography, autofluorescence. For citation: Moshetova L.K., Alekseev I.B., Vorob’eva I.V., Nam Yu.A. Retinal status in moderate myopia and age-related macular degeneration. Management strategies. Russian Journal of Clinical Ophthalmology. 2022;22(2):91–98 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-91-98. <br

Ocular changes after simultaneous kidney-pancreas transplant

I.V. Vorobyeva1, E.V. Bulava1, L.K. Moshetova1, A.V. Pinchuk2–4 1Russian Medical Academy of Continuous Professional Education, Moscow,&nbsp; &nbsp;Russian Federation 2N.V. Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russian Federation 3A.I. Yevdokimov Moscow University of Medicine &amp; Dentistry, Moscow, Russian Federation 4Research Institute of Public Health Organization and Medical Management, Moscow,&nbsp;&nbsp;&nbsp;Russian Federation Type 1 diabetes (T1D) is one of the most common chronic diseases in young individuals. Diabetic nephropathy, being one of the most dangerous complications of T1D, progresses to end-stage renal disease within 10–15 years in 80%. The simultaneous kidney-pancreas transplant prevents insulin therapy and dialysis, thereby avoiding further progression of complications of diabetes. Normalization of carbohydrate metabolism and resolving of uremia after simultaneous kidney-pancreas transplant are beneficial for ocular structures. This article reviews studies on the pattern of changes in ocular structures in the post-transplant period. The procedure improves peripheral microcirculation of the bulbar conjunctiva and corneal innervation. Most studies demonstrate stabilization and improvement of the course of diabetic retinopathy as illustrated by the reduction in active vascular proliferation, need for retinal laser photocoagulation and vitrectomy. Meanwhile, some studi es failed to reveal any differences in the morphological functional status of the retina in the pre- and postoperative periods.&nbsp;An increase in&nbsp;cataract rate among simultaneous kidney-pancreas transplant recipients receiving immunosuppressant therapy remains a challenge. Keywords: type 1 diabetes, kidney transplant, pancreas transplant, simultaneous kidney-pancreas transplant, diabetic retinopathy, diabetic macular edema. For citation: Vorobyeva I.V., Bulava E.V., Moshetova L.K., Pinchuk A.V. Ocular changes after simultaneous kidney-pancreas transplant. Russian Journal of Clinical Ophthalmology. 2022;22(2):132–136 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-132-136. </p