Impact of glaucoma and glaucoma surgery on quality of life

V.P. Erichev, A.V. Volzhanin Scientific Research Institute of Eye Diseases, Moscow, Russian Federation Glaucoma is a chronic, incurable disease managed by controlling intraocular pressure (IOP). Meanwhile, vision loss in glaucoma and treatments affect the quality of life (QoL). Many studies on QoL in patients with glaucoma are now available. Standardized questionnaires and established non-linear relationships between QoL in glaucoma and clinically assessed quantitative parameters (e.g., visual acuity, visual fields, etc.) are significant achievements. Although treatments (pharmacotherapy or surgical interventions) generally reduce IOP, their adverse reactions affect QoL and treatment adherence. Surgical interventions provide the most potent IOP-lowering effect. However, surgery most affects QoL due to local symptoms and psychological factors (particularly at the early stages of glaucoma). Given the emergence of&nbsp;minimally invasive procedures, the importance of studying de facto QoL after glaucoma surgery is resurrected. Keywords: quality of life, glaucoma, trabeculectomy,&nbsp; minimally invasive glaucoma surgery, neuroprotective therapy. For citation: Erichev V.P., Volzhanin A.V. Impact of glaucoma and glaucoma surgery on quality of life. Russian Journal of Clinical Ophthalmology. 2022;22(1):44–50 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-44-50. <br

Hypotony maculopathy after glaucoma surgery: pathogenic mechanisms, diagnostic tools, and treatment modalites

V.P.&nbsp;Erichev, S.Yu. Petrov, N.A.&nbsp;Orekhova, L.Kh. El’murzaeva Scientific Research Institute of Eye Diseases, Moscow, Russian Federation This article reviews risk factors, mechanisms of the development, key diagnostic tools, therapeutic and preventive modalities for hypotony maculopathy. Hypotony maculopathy is a rare complication whose rate has increased after wide adoption of glaucoma surgery. Risk factors for hypotony maculopathy are younger age, male sex, myopia, and primary glaucoma surgery using antimetabolites. Major diagnostic tools for hypotony maculopathy to assess the abnormalities and their changes over time are ultrasound (to provide differential diagnosis in poor fundus visualization), fluorescent angiography (to identify choroidal folds and to differentiate between choroidal and retinal folds), and optical coherence tomography.&nbsp;Therapeutic modalities include conservative methods (i.e., bandage contact lenses to prevent excessive filtration, compressive conjunctival sutures) and surgical procedures (i.e., scleral flap revision, intracameral gas injection, vitrectomy using perfluorocarbon gas, fistula plugging followed by trabeculectomy ab interno). Early and correct identification of the cause of hypotony guarantees treatment success. Keywords: glaucoma, hypotony maculopathy, fistulizing glaucoma surgery, antimetabolites, needling, diagnostics. For citation: Erichev V.P., Petrov S.Yu., Orekhova N.A., El’murzaeva L.Kh. Hypotony maculopathy after glaucoma surgery: pathogenic mechanisms, diagnostic tools, and treatment modalites. Russian Journal of Clinical Ophthalmology. 2020;20(1):–31. DOI: 10.32364/2311-7729-2020-20-1-26-31. <br

Morphological and functional retinal changes in postoperative hypotony

V.P. Erichev, A.A. Antonov, A.A. Vitkov, E.A. Ragozina, A.V. Volzhanin Scientific Research Institute of Eye Diseases, Moscow, Russian Federation Aim: to analyze the retinal microvascular network changes in hypotony maculopathy after non-penetrating deep sclerectomy (NPDS). Patients and Methods: the study enrolled 35 patients (35 eyes) with uncontrolled glaucoma stages II and III in whom the intraocular pressure (IOP) level was less than 10 mm Hg after NPDS. In addition to a standard eye exam, all patients underwent optical coherence tomography angiography (OCTA) before and one day after surgery. In addition, the radial peripapillary capillary (RPC) network vessel density (VD) on 4×4-mm optic nerve scans, superficial vascular plexus (SVP) VD on 6×6-mm macular scans, and foveal avascular zone (FAZ) area on 3×3-mm scans were evaluated. Results: IOP-lowering effect was reported in all patients, i.e., IOP level reduced by, on average, 17.7±8.3 mm Hg. In 15 patients, baseline OCTA parameters worsened (group 1). In 17 patients, OCTA parameters improved (group 2). In 3 patients, OCTA parameters remained unchanged (group 3). In group 1, parafoveal VD reduced by 1.5% [2.45%; 0.85%] in the superior sector and 1.3% [1.75%; 0.85%] in the inferior sector. Peripapillary VD reduced by 0.6% [2.0%; 0.1%] in the superior sector and 1.1% [2.4%; 0.0%] in the inferior sector. In group 2, parafoveal VD improved by 0.85% [0.0%; 1.75%] in the superior sector and 1.2% [0.68%; 2.6%] in the inferior sector. Peripapillary VD improved by 1.2% [0.18%; 2.0%] in the superior sector and 0.95% [0.05%; 1.75%] in the inferior sector. IOP levels were similar. No correlations between OCTA parameters and IOP levels were revealed. Postoperatively, the FAZ area remained unchanged. Conclusions: postoperative hypotoni a has a positive and negative impact on the retinal microvascular network. OCTA findings after NPDS demonstrate no correlations with IOP levels. Further studies are needed to identify prognostic factors of hypotony maculopathy and assess its long-term effects on retinal vessels. Keywords: glaucoma, non-penetrating deep sclerectomy, hypotony maculopathy, OCTA. For citation: Erichev V.P., Antonov A.A., Vitkov A.A. et al. Morphological and functional retinal changes in postoperative hypotony. Russian Journal of Clinical Ophthalmology. 2021;21(4):187–193 (in Russ.). DOI: 10.32364/2311-7729-2021-21-4-187-193. </p

Systemic risk factors for developing of primary open-angle glaucoma

E.A. Egorov1, V.P. Erichev2, A.L. Onishchenko3, S.Yu. Petrov2, A.V. Kuroyedov1,4,&nbsp;A.A. Antonov2, A.A. Vitkov5 1 Pirogov Russian National Research Medical University, Moscow, Russian Federation 2 Scientific Research Institute of Eye Diseases, Moscow, Russian Federation 3 Novokuznetsk State Institute of Postgraduate Medicine — branch of Russian Medical &nbsp;Academy of Continuous Professional Education, Russian Federation 4 Central Military Clinical Hospital named after P. V. Mandryka, Moscow, Russian Federation 5 Sechenov University, Moscow, Russian Federation Abstract Primary open-angle glaucoma (POAG) is a disease that manifests itself in the late stages and leads to irreversible vision loss. Regular preventive examinations of the population contribute to the timely detection of patients with early stages of glaucoma, as well as the formation of risk groups based on medical history. The presence of concomitant systemic disease is an important risk factor, which can lead to the development or progression of glaucoma.&nbsp; Currently, there are many studies, devoted to examination of the possible relationship between systemic diseases and glaucoma. Diabetes mellitus and arterial hypertension are considered to be the most studied systemic risk factors. There is the evidence of the possible impact of hypothyroidism and obesity on the resistance of outflow of intraocular fluid and increase in intraocular pressure. The aim of this review is to summarize current data on systemic risk factors for POAG, which can contribute to a better understanding of the principles of glaucoma and to plan diagnostics taking into account the assessment of all risks. Such an approach will help to timely diagnose glaucoma and prevent irreversible irreversible vision loss. Key words: primary open-angle glaucoma, risk factors, diabetes mellitus, arterial hypertension, hypothyroidism, obesity, Helicobacter pylori. For citation: Egorov E.A., Erichev V.P., Onishchenko A.L. et al. Systemic risk factors for developing of primary open-angle glaucoma. RMJ “Clinical ophthalmology”. 2018;3:140–145.<br

Alpha-adrenergic receptor agonists in terms of modern views on glaucoma monitoring and treatment

The article reviews historical aspects of direct and indirect (by reducing intraocular pressure (IOP)) neuroprotective effect of brimonidine in terms of modern views on glaucoma monitoring and treatment. Brimonidine, a selective alpha-adrenergic receptor agonist, is the first-line treatment choice for glaucoma. This agent reduces IOP by decreasing aqueous humor production and improving uveoscleral outflow. The result is the achievement of target IOP. Brimonidine prevents ganglionic cell death in glaucomatous optic neuropathy. Several in vitro and in vivo studies describe the mechanism of preventing mitochondrial dysfunction and excitotoxic retinal cell damage in ischemia. Brimonidine affects NMDA receptors, inhibits proapoptotic protein expression, activates neurotrophic processes, and normalizes oxidative phosphorylation thus preventing mitochondrial dysfunction.&nbsp; According to the modern concept, the aim of glaucoma treatment is to avoid vision loss by preventing ganglionic cell death. Therefore, lifelong visual field monitoring and neuroprotective therapy are required. Brimonidine provides target IOP and prevents retinal cell death thus preserving vision in glaucoma.&nbsp; Keywords: glaucoma, intraocular pressure, neuroprotection, visual field, monitoring, brimonidine, Luxfen.&nbsp; For citation: Erichev V.P., Petrov S.Yu., Volzhanin A.V. et al. Alpha-adrenergic receptor agonists in terms of modern views on glaucoma monitoring and treatment. Russian Journal of Clinical Ophthalmology. 2019;19(2):87–91.&nbsp; About the authors: 1Valery P. Erichev — MD, PhD, Professor, Head of Glaucoma Department, ORCID iD 0000-0001-6842-7164; 1Sergey Yu. Petrov — MD, PhD, Leading Research Associate of Glaucoma Department, ORCID iD 0000-0001-6922-0464; 1Andrey V. Volzhanin — postgraduate, ORCID iD 0000-0002-1421-8882; 1Darya M. Safonova — MD, PhD, Junior Research Associate of Modern Treatmen in Ophthalmology, ORCID iD 0000-0002-5082-1494; 2Tamara V. Yaremenko — postgraduate, ORCID iD 0000-0002-3094-1958; 3Serzh A. Kazaryan — resident, ORCID iD 0000-0003-2258-2964. 1Reseach Institute of Eye Diseases. 11A Rossolimo str., Moscow, 119021, Russian Federation. 2Sechenov University. 8 Trubeckaya Str., Moscow, 119146, Russian Federation. 3Mkhitar Heratsi Yerevan State Medical University. 2 Koryuna str., Erevan, 0025, Republic of Armenia. Contact information:&nbsp;Andrey V. Volzhanin, 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;11.04.2019. </p

Ophthalmic risk factors for primary open angle glaucoma

Primary open angle glaucoma (POAG) is a chronic progressive optic neuropathy, characterized by morphological changes in the optic nerve head and retinal nerve fiber layer. This review analyzes the development of the risk factors for POAG over several decades. The role of systemic diseases as a risk factor has been proven, and ophthalmological factors contributing to the progression of glaucoma are currently being actively studied. The most studied of these is ocular hypertension. A number of studies have shown an effect of both the average increase in the level of intraocular pressure (IOP) and its peak rises during the day on the progression of glaucomatous optic neuropathy (GON). Pseudoexfoliation syndrome and pigment dispersion syndrome, which are characterized by changes in the structures of the eye that increase the sensitivity of the nervous tissue to IOP level differences, can lead to increased IOP levels. An increase in the axial length of the eye associated with myopia is also considered to be a risk factor for the POAG development. In myopia, especially when high severity, there is a stretching of the fibrous tunic of the eye and changes in the structures of the fundus. These changes may be mistakenly diagnosed as glaucomatous, and may also contribute to the GON development. This review provides a summary of current data on the ophthalmic risk factors for the POAG development, which will improve the diagnosis of this disease.&nbsp; Keywords: primary open angle glaucoma, risk factor, ocular hypertension, pseudoexfoliation syndrome, pigment dispersion syndrome, myopia, myopic refraction.&nbsp; For citation: Erichev V.P., Onishchenko A.L., Kuroyedov A.V. et al. Ophthalmic risk factors for primary open angle glaucoma. Russian Journal of Clinical Ophthalmology. 2019;19(2):81–86.&nbsp; 1Valery P. Erichev — MD, PhD, Professor, Head of Glaucoma Department, ORCHID iD 0000-0001-6842-7164; 2Aleksandr L. Onishchenko — MD, PhD, Professor, Deputy Director for Scientific Work, ORCHID iD 0000-0002-1549-5742; 3,4Aleksandr V. Kuroyedov — MD, PhD, Professor, Head of Ophthalmological Department, ORCHID iD 0000-0001-9606-0566; 1Sergey Yu. Petrov — MD, PhD, Senior Researcher of Glaucoma Department, ORCHID iD 0000-0001-6922-0464; 5Andrey Yu. Brezhnev — MD, PhD, Associate Professor of Ophthalmological Department, ORCHID iD 0000-0002-5597-983X; 1Alexey A. Antonov — MD, PhD, Senior Researcher of Glaucoma Department, ORCHID iD 0000-0002-5171-8261; 1Aleksandr A. Vitkov — resident physician, ORCHID iD 0000-0001-7735-9650; 6Yuliya K. Murakhovskaya — student, ORCHID iD 0000-0002-1251-6405. 1Scientific Research Institute of Eye Diseases. 11A, Rossolimo str., Moscow, 119021, Russian Federation. 2Novokuznetsk State Institute of Continuing Medical Education — branch of Russian Medical Academy of Continuing Professional Education. 5, Stroiteley prospect, Novokuznetsk, Kemerovo region, 654005, Russian Federation. 3&nbsp;Pirogov Russian National Research Medical University. 1, Ostrovityanova str., Moscow, 117997, Russian Federation. 4Central Military Clinical Hospital named after P.V. Mandryka. 8A, B. Olenya str., Moscow, 107014, Russian Federation.&nbsp; 5Kursk State Medical University. 3, Karl Marx str., Kursk, 305041, Russian Federation.&nbsp; 6Sechenov University. 8/2, Trubetskaya str., Moscow, 119991, Russian Federation.&nbsp; Contact information:&nbsp;Aleksandr L. Onishchenkо,&nbsp; 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;13.12.2018. </p

Glaucoma &quot;landscape&quot; in Russia, CIS and Eastern European countries: what has changed over 15 years?

A.Yu. Brezhnev1, E.A. Egorov2, V.P. Erichev3, A.V. Kuroedov2,4, P.Ch. Zavadsky5, M. Bozic6, N.N. Voronova7, M.F. Dzhumova8, N.V. Ivanova7, T.A. Imshenetskaya9, T.G. Kamenskikh10, O.I. Lebedev11, L.N. Marchenko8, A.L. Onishchenko12, N.A. Sobyanin13, V.F. Ekgardt14 1Kursk State Medical University, Kursk, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation 3Krasnov Research Institute of Eye Diseases, Moscow, Russian Federation 4P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 5LLC "Ophthalmological Center of Karelia", Petrozavodsk, Russian Federation 6University Eye Clinic, University of Belgrade, Belgrade, Serbia 7V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation 8Belarusian State Medical University, Minsk, Belarus 9Belarusian Medical Academy of Post-Diploma Education, Minsk, Belarus 10V.I. Razumovskiy Saratov State Medical University, Saratov, Russian Federation 11Omsk State Medical University, Omsk, Russian Federation 12Novokuznetsk State Institute for Advanced medical Education — Branch of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russian Federation 13F.Kh. Gral City Clinical Hospital No. 2, Perm, Russian Federation 14South Ural State Medical University, Chelyabinsk, Russian Federation Aim: to assess the changes in clinical and epidemiological characteristics, diagnostic and treatment options of primary open-angle glaucoma (POAG) in the Russian Federation and multiple near- and far-abroad countries over the period of 2005–2020. Patients and Methods: the final protocol of this retrospective multi-center research and clinical study included 289 patients with POAG from 7 states (Russia, Belarus, Serbia, Moldova, Kyrgyzstan, Slovakia, and Slovenia). The authors analyzed the methods used for establishing POAP diagnosis, clinical and demographic patient characteristics (gender, age and place of residence), as well as the process of glaucoma development (age of onset, disease duration and stages, intraocular pressure, ocular hypotensive medications, and the used laser and surgical procedures). All patients were divided into four groups depending on the time of making the initial diagnosis: 2004–2005, 2009–2010, 2014–2015, 2019–2020. Results: tonometry with Maklakov and Goldmann tonometers is still considered the gold standard for measuring intraocular pressure (IOP) (95% of cases). The percentage of pneumotonometry increased from 40% in 2005 to 60% in 2020. Approximately a third of clinics are still using electronic tonography as a supplementary method. Static automated perimetry is a basic tool for diagnosis and follow-up of patients with POAG (more than 95% of cases). Manual kinetic perimetry (Foerster's perimetry) is used in less than 10% of cases. Ophthalmoscopy (direct and binocular) was involved in the diagnostic process in all clinics and in all cases. The range of instrumental visualization technologies includes optical coherence tomography (OCT), Heidelberg Retina Tomography (HRT), and scanning laser polarimetry. Currently, OCT is utilized in 90% of clinics. It was found out that in 2005 the standard of initial POAG diagnosis encompassed a set of Maklakov/Goldmann tonometry, ophthalmoscopy and kinetic perimetry. In 2020, this list includes Maklakov/Goldmann tonometry, pneumotonometry as a supplemental tool, static automated perimetry, ophthalmoscopy and OCT. The percentage of newly diagnosed POAG at the early stage has increased twofold over the past 15 years (from 20% in 2005 to 38% in 2020). The mean age of patients at the time of initial POAG diagnosis in 2005 was 62 (52; 67) years, in 2020 — 65 (50; 70) years, respectively (р=0.694). The proportion of prostaglandins in medication therapy increased by 20% over the past 15 years, while the proportion of beta-blockers reduced by the same percentage. The use of cholinomimetic drugs was almost discontinued. The total number of glaucoma laser surgeries has grown, and in the last decade the top priority has been given to selective laser trabeculoplasty, while the share of argon laser trabeculoplasty has decreased by 10%. The rate of primary glaucoma surgeries (trabeculectomy) keeps going down. Conclusion: a gradual and consistent implementation of high-tech diagnostic methods (static automated perimetry and OCT) in the routine practice occurred over 2005–2020. Also, there was a clear trend in more extensive use of objective data. The evolution of pharmaceutical "landscape" in the disease management is associated with an increasing proportion of more effective and safe drugs (prostaglandin analogues) and a diminishing role of beta-blockers as drugs of choice for starting therapy. The share of glaucoma surgeries as a starting strategy of POAG management was running down steadily from 2005 to 2010. Keywords: glaucoma, intraocular pressure, tonometry, perimetry, optical coherence tomography, trabeculectomy. For citation: Brezhnev A.Yu., Egorov E.A., Erichev V.P. et al. Glaucoma "landscape" in Russia, CIS and Eastern European countries: what has changed over 15 years? Russian Journal of Clinical Ophthalmology. 2023;23(2):73–79 (in Russ.). DOI: 10.32364/2311-7729-2023-23-2-73-79.&nbsp; </p