What is Glaucoma, causes, treatment!
1-The causes of glaucoma:2-Diagnosis and treatment of glaucoma:3-For the treatment of glaucoma used:4-Surgical treatment of glaucoma.
Glaucoma - a chronic eye disease in which increased intraocular pressure (IOP) and the optic nerve is affected. In this vision is reduced until the onset blindness. Blindness generated by glaucoma is irreversible as the optic nerve dies. Back view blinded in this case, the patient is no longer possible!
With early detection and proper treatment, thanks to modern techniques, the majority of patients with glaucoma can not save vision.
Unfortunately, glaucoma - a fairly common disease. They predominantly affect people over the age of 40 years. But this disease can strike and young people (youth glaucoma) and even newborns (congenital glaucoma).
Today Ophthalmology knew only one way to prevent blindness in glaucoma: Early detection and proper treatment.
The causes of glaucoma:
Normally inside the eye produces a special intraocular fluid. Per day produced in the eye of about 4 ml and the same fluid flows out. The main route of outflow of intraocular fluid - the angle of the anterior chamber, where there is a special drainage system.
The balance between the amount of fluid produced in the eye and the fluid flowing out of the eye provides a constant intraocular pressure. Normal figures of intraocular pressure are individual, but on average, they vary between 16-25 mm Hg.
Increased intraocular pressure results in a compression of nerve fibers. The vessels that nourish the optic nerve, bend, and its blood supply is disrupted significantly. If the optic nerve is in this state all the time, it atrophies and vision deteriorates.
For glaucoma is characterized by three main features:
1. The increased intraocular pressure
2. The narrowing of the field of view (Figure 1)
3. The development of atrophy (destruction) of the optic nerve. (Fig. 2)
Diagnosis and treatment of glaucoma:
Providing high-quality care in glaucoma - a very important task. The need for such assistance in the Lower Volga region is very high.
9000 patients were examined in 2006, of which 1177 patients received conservative glaucoma, laser or surgery.
Diagnosing glaucoma requires the following main research:
measurement of intraocular pressure (tonometry);
study visual field (perimetry);
determining the status of the optic nerve in the eye fundus examination (ophthalmoscopy).
The results of these studies will allow the doctor to recommend you the necessary treatment. There are 3 main methods of glaucoma treatment: medical, laser and surgical.
For diagnostic use the most modern equipment:
Computer peri graf "Perico";
computer oftalmotonografy "OTG-03" and "60-GlauTest".
Diagnosing glaucoma includes standard ophthalmologic examination (ophthalmoscopy, biomicroscopy), field testing of the perimeter "Perico", a study of intraocular pressure (computer tonosfigmografiyu), optical coherence tomography of the optic nerve, ultrasound biomicroscopy, examination angle of the anterior chamber of the eye (gonioscopy), various load and unloading tests for the early diagnosis of glaucoma.
For the treatment of glaucoma used:
Argon Coagulator Nidek AC - 2300 (Japan);
Nd: YAG laser Nidek YC-1300 (Japan)
Nd: YAG Alex Laser Super Q (Australia) laser
Diode coagulator Oculight SLx Iris Medical (USA) with tips for cycle photocoagulation
As such methods of treating glaucoma, a conservative treatment (selection of preparations and their application mode, which provides a robust compensation of intraocular pressure), laser treatment (laser trabeculoplasty, iridectomy, cyclo photocoagulation) and surgery (penetrating deep sclerotic ectomy and deep splenectomy, trans-scleral drainage posterior chamber of the eye).
Operation penetrating deep splenectomy (NDSE), it was proposed by Acad. SN Fedorov (1986). The main advantages of NDSE are: ensuring controlled water filtration membrane consisting of Descemet's membrane and the inner wall of Schlemm's canal (trabeculae), which regulates the soft water filtration and eliminates sudden changes in IOP in the direction of hypotension leading to the well-known complications; no perforation of the eyeball, which allows the patient to move actively in the next few hours after the operation, and the operation to translate into the category of outpatient; the ability to enhance the filtration of moisture at different times of the postoperative period by YAG-laser perforation "filter membrane" (Descemet's membrane and trabeculae) in the cases of decompensation IOP.
Doctors participating in Russian and international scientific conferences.
The Office has been obtained 11 patents for inventions of the Russian Federation.
Subject scientific works employees - development and introduction of new methods of diagnosis of glaucoma, an analysis of the effectiveness of its methods of treatment.
So, are patented and introduced into clinical practice the latest techniques of evaluation of patients with suspected glaucoma "Tonosfigmografichesky way to study individual tolerance (tolerance) intraocular pressure", "a way to study the sensitivity of the optic nerve to the increased intolerance intraocular pressure", "method of differential tonometry", "the way of the primary angle-closure glaucoma predict" and others.
The original tonosfigmografichesky way to study individual tolerance allows the intraocular pressure in terms of hemodynamics (blood flow) of the eye to determine a particular patient the upper limit of the individual rules of intraocular pressure, and therefore more accurate to carry out his treatment of glaucoma.
A method of investigating the sensitivity of the optic nerve to the increased intolerance intraocular pressure allows for early diagnosis of primary glaucoma, the differential diagnosis between primary glaucoma and ocular hypertension, glaucoma between normotensive and psevdoglaukomoy (false glaucoma). The method is based on an artificial povysheniivnutriglaznogo pressure and vyavleniya defects in the field of view with a unique computer program - selective static perimetry. "The method of differential tonometry" allows you to accurately measure the intraocular pressure of the patient, taking into account his individual characteristics of the eye (including the cornea thickness, anteroposterior size and clinical refraction of the eyeball). A study carried out on a computer tomography according to the dynamic differential tonometry on Fridenvaldu.
For his work "On tolerance and target intraocular pressure in primary open angle glaucoma" in 2008 received a grant of Russian society glaucoma.
In 2010, the Ministry of Health and Social Development approved medical technology "Tonosfigmografichesky method for determination of tolerant and target intraocular pressure in patients with glaucoma," the authors Fokin VP, Balin SV Gushchin AV (Number and date of registration technology Roszdravnadzor: FS-2010/321 dated 03 September 2010).
Do you have questions, comments or suggestions regarding the operation of the entire branch or its separate divisions?
Medication (conservative) treatment of primary glaucoma
Currently, medical treatment of glaucoma is carried out in three main areas:
- Therapy aimed at reducing intraocular pressure (oftalmogipotenzivnaya therapy);
- Therapy helps to improve blood supply to the internal eye membranes and intraocular portion of the optic nerve;
-therapy aimed at the normalization of metabolic processes (metabolism) in the tissues of the eye to influencing the degenerative processes that are typical for glaucoma.
You must immediately specify that a key element in the treatment of glaucoma is to normalize the level of intraocular pressure (IOP), and methods to improve blood circulation and effects on the metabolic processes in the eye are merely auxiliary. A known medicinal value has the correct mode of work and life of glaucoma patients. m.
Appointment of drugs that lower intraocular pressure (IOP) is the prerogative
Laser surgical treatment of glaucoma.
Laser methods correcting intraocular pressure (IOP) and postoperative complications play an important role in the treatment of glaucoma. It should be noted that the priority in the development of laser treatments in ophthalmology belong to Russian scientists.
The advantages of laser surgery:
Small traumatic procedures
no serious Intra- and postoperative complications,
the possibility of treatment in an outpatient setting,
the possibility of repeated laser surgery, while reducing the hypotensive effect in the remote postoperative period.
The main types of laser surgery for glaucoma are:
laser iridectomy (LIE)
selective laser trabeculoplasty (SLT)
genioplasties,
destsemetogoniopunktura (BPH)
cyclol photocoagulation (DSC).
Laser iridectomy (LIE) - laser iridectomy is widely used to treat
closure or narrow-angle glaucoma, acute glaucoma attack or prophylaxis. Using a laser beam in the root of the iris is formed a small hole - coloboma through which the intraocular fluid passes freely from the rear chamber to the front, to the outflow paths. This additional path for fluid flow pressure are equalized between the front and rear camera, iris root opens the drainage network, improving the outflow of intraocular fluid and reduces the intraocular pressure.
Even with normal intraocular pressure in a closed or narrow-angle of the anterior chamber in most cases requires conducting laser iridotomy to prevent the acute attack of glaucoma.
Selective laser trabeculoplasty (SLT). Implementation of selective laser trabeculoplasty is indicated in patients with open-angle glaucoma, preferably in the initial stages of the process. Selective trabeculoplasty (SLT) has a minimal damaging effect on tissues of the anterior chamber angle, which allows to use it repeatedly. SLT has a highly selective mechanism of action, affecting cells only, soderzhischie pigment facilitating cleaning and remodeling of drainage network, which leads to an improvement in the outflow of intraocular fluid.
Indications for selective laser trabeculoplasty:
Primary open angle glaucoma Step 1-2-3 with elevated IOP;
Lack of effect of antihypertensive drug therapy;
The use of more than 2 antihypertensive drugs to achieve a tolerant IOP;
The presence of contraindications to the use of antihypertensive drugs.
Trans-scleral cyclophotocoagulation (TTSFK).
Suitable diode coagulator Oculight SLx Iris Medical (USA). The laser transscleral action is carried out at 18 points along the arc of 2700 1-1.2 mm from the limbus: Power 1500-2000 mV, 2 seconds exposure. noninvasively with a special fiber optic probe for manual selective destruction ciliary processes.
Indications for trans-scleral cyclol photocoagulation:
terminal aching primary and secondary glaucoma with high IOP,
unyielding traditional methods of treating non-compensated primary glaucoma, mainly in the far-advanced stage.
Surgical treatment of glaucoma.
Surgery to create a new path for the outflow of intraocular fluid, made as early as possible, ensure the preservation of vision in patients with glaucoma. This fundamentally new operation developed in the IRTC "Eye Microsurgery", called "penetrating deep sclerotic ectomy" - NDSE. The most important advantage of this operation is its execution without opening the eyeball, which eliminates the possibility of infection and reduces the risk of complications during surgery. Penetrating deep sclerotic ectomy performed under local anesthesia. The operation is performed with the use of the modern operating microscope. For its implementation uses special microsurgical instruments with blades made of diamond, sapphire and other high-strength materials. The duration of the operation - an average of 20 minutes.
Please be aware that after 1-6 months NDSE, in the case of intraocular pressure increase above 22 mm. Hg. Art. is shown holding a laser destsemetogoniopunktury.
In addition to penetrating deep splenectomy, according to testimony and other kinds of used glaucoma operations: deep splenectomy, valve implantation Ahmed transtsiliarnoe drain back of the camera, the combined surgery (cataract extraction + glaucoma surgery).
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