[Phacoemulsification in prevention of acute angle-closure glaucoma attack]

Analysis of the effectiveness of preventative phacoemulsification (PE) in anatomically short eyes with an increased risk of an acute glaucoma attack in thickened lens can help in choosing the optimal management tactics for these patients.

PURPOSE

To study the changes in morphometric parameters of the anterior segment of anatomically short eyes with an increased risk of acute glaucoma attack before and after preventative PE.

MATERIAL AND METHODS

The study included 70 patients (70 eyes) with a high risk of acute glaucoma attack in short anatomical axial length and thickened lens, with posterior and middle positions of the ciliary body. They were divided into 2 groups: the main group consisted of 45 patients who agreed to undergo PE; the comparison group consisted of 25 patients who refused to undergo PE due to good visual functions and no complaints about vision. B-mode ultrasound examination of the anterior segment of the eye was used to evaluate the cross-sectional surface area of the lens (CSAL) and the cross-sectional surface area of the anterior chamber (CSAAC).

RESULTS

In the main group, on day 2-3 after PE the anterior chamber depth increased in all eyes, the CSAAC index increased, the anterior chamber angle (ACA) widened to Schaffer grade to II-III. After 1-3 years and 4-5 years, the anterior chamber depth, the CSAAC index and the width of the ACA remained stable. In the comparison group, after 1-3 years the anterior chamber depth and the CSAAC index significantly decreased, the ACA narrowed, and the intraocular pressure increased; after 4-5 years, there was a progressive increase in the CSAL index, the ACA was completely closed (0°).

CONCLUSION

In all cases of timely performed preventative PE, already on days 2-3 after surgery there was a statistically significant improvement in the main morphometric parameters of the eye, which remained stable for 4-5 years.

[Features of retinal blood flow in pregnant women with carbohydrate metabolism disorders]

Studying the condition of retinal blood flow in pregnant women with disorders of carbohydrate metabolism contributes to early detection of diabetic retinopathy (DR), which is necessary for timely treatment and preservation of high visual functions.

PURPOSE

To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA) in order to determine the criteria for manifestation and progression of DR.

MATERIAL AND METHODS

The study examined 203 pregnant women in the third trimester: 24 - with type 1 and 2 diabetes (T1D and T2D), 143 - with gestational diabetes (GD), and 36 apparently healthy women with physiological pregnancy that comprised the control group. OCTA imaging was performed on RTVue XR Avanti ("Optovue", USA) system using HD Angio Retina 6.0 mm² scan protocol. The whole image vessel density (wiVD), foveal vessel density (FVD), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied.

RESULTS

FVD was significantly lower in pregnant women with diabetes than in pregnant women with GD and in the control group, prompting an assumption that retinal microvascular regulation changes because of chronic disturbances of carbohydrate metabolism in such patients and due to development of microangiopathy. Statistically significant increase in FAZ area and decrease in wiVD were revealed in patients with DR compared to data from the group of pregnant women with diabetes but without DR, in the absence of differences in FVD. In 2 patients with T1D and no ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye.

CONCLUSION

OCTA can help identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes and no ophthalmoscopic signs of DR, and determine objective indications for timely retinal laser coagulation.

[Development of additive systemic effects when taking β-blockers in patients with glaucoma and concurrent chronic diseases]

Examining the somatic state of glaucomatous patients that enroll for treatment, we are increasingly confronted with a serious problem of inconsistency in prescribing beta-blockers (β-blockers) by ophthalmologists, cardiologists and therapists.

PURPOSE

To assess the frequency and extent of adverse reactions at simultaneous local and systemic prescription of β-blockers to patients with glaucoma and systemic vascular pathology.

MATERIAL AND METHODS

The study included 112 patients that have been taking β-blockers for at least 6 months. The main group consisted of 39 patients with primary open-angle glaucoma (POAG) in combination with cardiovascular disease; the first comparison group - 36 patients with POAG without systemic vascular pathology; the second comparison group - 37 patients with systemic vascular pathology without glaucoma. In the main and first comparison groups, double instillations of 0.5% timolol or 0.5% betaxolol were used as monotherapy.

RESULTS

Adverse reactions to the long-term usage of β-blockers were found in 82% of the main group patients with cardiovascular diseases. They manifested as bradycardia or bronchospasm (38% patients), combination of bradycardia and vascular hypotension or bronchospasm (18%), or combination of 3-4 types of adverse reactions (26%); in the first and second comparison groups - in 36% and 30%, respectively (p<0.05).

CONCLUSION

The most severe multifactorial adverse reactions developed due to long-term use of combinations of systemic and local β-blockers: 100 mg metoprolol or 10 mg bisoprolol with 0.5% timolol.