ЗЕМЛИ СЕЛЬСКИХ НАСЕЛЁННЫХ ПУНКТОВ

СМ. ЗЕМЛИ НАСЕЛЕННЫХ ПУНКТО

Glaucoma Normal-tension Glaucoma

Normal tension glaucoma (NTG) is a subvariant of primary open angle glaucoma (POAG) or a separate entity. NTG is defined as chronic open angle glaucoma without elevated intraocular pressure or normal intraocular pressure. Normal intraocular pressure is between 10 and 21 mmHg and is defined as two times the standard deviation of the mean intraocular pressure in the normal population. In addition to the absence of elevated intraocular pressure, all the classic symptoms of glaucoma are otherwise present. These include a conspicuous glaucomatous optic disc excavation, nerve fibre bundle defects, and corresponding visual field defects. Papillary rim haemorrhages are frequently found. The visual field defects in NDG are usually more central compared to POAG and are therefore described as more disturbing by the patient. The anterior chamber angle is open and there are no other changes suggestive of secondary glaucoma (pigment dispersion, pseudo-exfoliation). The exact pathophysiology of NDG is not well understood. Pathophysiologically, circulatory disturbances in the sense of arterial hypo- as well as hypertension may play an essential role or at least increase the susceptibility of the optic nerve to intraocular pressure fluctuations as well as blood pressure dips. Therefore, this requires not only a purely ophthalmologic but also interdisciplinary treatment of the patient with confirmed NDG. The primary goal of treatment is the reduction of intraocular pressure, which can stop the disease. This article gives an overview of epidemiology, aetiology, clinical findings and therapies

Real Life Data on Efficacy and Safety of Topical NGF Eye Drops (Cenegermin)

Background Topical NGF eye drops (Cenegermin) were approved in 2015 as an orphan drug for the treatment of neurotrophic keratopathy (NK). The active substance Cenegermin is a recombinant form of human NGF (nerve growth factor). Objectives Presentation of efficacy and safety of Cenegermin for use in patients in an university real-life setting. Material and Methods Retrospective study at the Koln University Eye Hospital from 2017 to 2019 with n = 11 eyes. Average follow-up was 13.5 +/- 7.1 months. Reasons for treatment were neurotrophic keratopathy stage II and III, clinically mostly in combination with corneal neovascularization. Results Seven eyes with a NK II and 4 eyes with a NK III with a median observation period of 13.6 months (range 1.2-20.3 months) from a total of 11 patients were included. The median patient age was 42.8 +/- 23.6 years (range 18-75 years). Before the start of therapy, the median erosion area measured 3.1 +/- 1.4 x 1.9 +/- 1.1 mm and the median ulcer area had a size of 2.3 +/- 1.1 x 2.1 +/- 0.8 mm. After the start of therapy with Cenegermin (application 6x/day), the epithelial defect closed in all 11 study eyes (100%) within 4-12 weeks (mean: 49 d +/- 9 d). In 9 out of 10 patients (90%) pre-existing corneal neovascularization regressed significantly (p <0.001). Before the start of therapy, a value in the Luneau test of 2.9 +/- 1.9 (minimum 1/6, maximum 4/6) was found and rose to a median value of 4.2 +/- 1.7 (minimum 2(6, maximum 6/6) after 18 months (p = 0.015). Therapy with Cenegermin had no long-term effect on intraocular pressure: the pressure ranged between 13.2 +/- 4.1 mmHg (minimum 8 mmHg, maximum 21 mmHg). Under therapy with NGF eye drops, 67% of the patients, after an initial decrease, showed a long-term improvement in visual acuity (BSCVA) from 0.72 +/- 0.31 to 0.46 +/- 0.29 logMAR after 18 months (p = 0.005). Relapses in form of a corneal erosion in the long-term follow-up were observed in only one eye. One patient had to stop therapy because of local pain, no other local and systemic side effects were observed. Conclusion This real-life series on the use of Cenegermin in a university context shows a good effectiveness of the substance for epithelial closure in various underlying diseases (100% within 12 weeks). There is a long-term improvement in vision and corneal sensitivity. Larger real-life cohorts with various underlying diseases should follow

Normal Tension Glaucoma

Normal tension glaucoma (NTG) is a subvariant of primary open angle glaucoma (POAG) or a separate entity. NTG is defined as chronic open angle glaucoma without elevated intraocular pressure or normal intraocular pressure. Normal intraocular pressure is between 10 and 21 mm Hg and is defined as two times the standard deviation of the mean intraocular pressure in the normal population. In addition to the absence of elevated intraocular pressure, all the classic symptoms of glaucoma are otherwise present. These include a conspicuous glaucomatous optic disc excavation, nerve fibre bundle defects, and corresponding visual field defects. Papillary rim haemorrhages are frequently found. The visual field defects in NDG are usually more central compared to POAG and are therefore described as more disturbing by the patient. The anterior chamber angle is open and there are no other changes suggestive of secondary glaucoma (pigment dispersion, pseudo-exfoliation). The exact pathophysiology of NDG is not well understood. Pathophysiologically, circulatory disturbances in the sense of arterial hypo- as well as hypertension may play an essential role or at least increase the susceptibility of the optic nerve to intraocular pressure fluctuations as well as blood pressure dips. Therefore, this requires not only a purely ophthalmologic but also interdisciplinary treatment of the patient with confirmed NDG. The primary goal of treatment is the reduction of intraocular pressure, which can stop the disease. This article gives an overview of epidemiology, aetiology, clinical findings and therapies