Method of treatment of primary open-angle glaucoma

FIELD: medicine; ophthalmology.

SUBSTANCE: carbonic anhydrase inhibitor is instilled. One day after medicamentous therapy started. Azopt therapy is combined with vasotonic massage of anterior ciliary arteries (ACA) that is transconjunctiva ACA effect using multiple alternation of their mechanical compression and decompression by vasotonometer.

EFFECT: higher efficiency of treatment of primary open-angle glaucoma and blood flow improvement of eye great vessel.

1 tbl, 1 ex

 

The invention relates to medicine, namely to ophthalmology.

It is known that deficiency of blood supply to the eye is one of the pathogenic stages of glaucoma process (Bunin YA et al., 1995). On the contrary, improve blood circulation of the eyes leads to stabilization of glaucoma with the positive dynamics of visual functions. To achieve this goal are vasoreconstructive surgery or conservative methods of influence on the blood flow. Last more popular and widespread because of its non invasiveness, however, are fairly standard, in particular with almost mandatory appointment of both General and local vasodilators without regard to the status of regional blood flow (Krasnov, M.M., 1989). For glaucomatous eyes before assigning vasodilators registration status of the local blood supply is unthinkable without pairing it with the state of the IOP. The interconnectedness and interdependence of hemodynamics and hydrodynamics of the eye is determined by the term "perfusion"whose status is assessed by perfusion pressure (PP) (Lobstein, A., Herr F., 1966). Calculation formula for PD has the following form:

,

where Rp ophth- perfusion pressure of the eye,

Pmophth- the average dynamic pressure in the ophthalmic artery,

Pioand the true intraocular pressure (IOP).

The described positive effect, confirmed ophthalmodynamometer data and manifested in the increase in perfusion pressure, the decrease in the absolute number of livestock in the field of view in the treatment of patients with open-angle glaucoma vasodilators (beksinski P.P., 2000). However, the impact of systemic vasodilators in the peripheral vessels, such as vessels of the eye, when the pressure-generating vessel causes the weakening of perfusion, which exacerbates the shortage of blood flow. The purpose of vasoconstrictors in local actions that could increase the pressure generating blood vessels in glaucoma is undesirable, first, because almost all of them (for example, adrenaline, mezaton, phenylephrine) have midriatichesky action, and secondly, even when the local application they affect the blood system, which is undesirable when often related primary open-angle glaucoma senile arteriosclerosis and hypertension.

As the closest analogue of our proposed method, we chose a method of treatment of open-angle glaucoma using installationname application of the inhibitor carbonhydrate - azopt (Petrevski A.V. et al., 2002). This drug in accordance with the mechanism of its action reduces the secretion of intraocular fluid, ormalized IOP and thereby increases perfusion pressure (see formula 1). However, it would be desirable to strengthen this influence of azopt on perfusion pressure through activation of the blood flow in the power structures of the eye blood vessels (see formula 1).

In connection with the foregoing features a method of treating primary open-angle glaucoma, consisting in a complex application of local anti-hypertensive medication and local non-drug vasotropic treatments.

Increased blood flow in the feeding eye vessels proposed to be undertaken by non-medical effects on the main blood vessels of the eye - anterior ciliary artery (OCA), which for the anterior eye segment (PSG) perform the role of major blood vessels (Hayreh SS, W.E. Scott, 1978). This effect is vazotonicheskih massage, representing the alternating compression and decompression of the OCA. Massage causes an additional inflow of blood flowing in such departments of the eye, as the ciliary body, the iris, the drainage area. During the development of the methodological aspects of Westonaria in the OCA was installed rise of pressure in these vessels by 50-100% when consistently performed with a small interval between them 3-4x dimensions, i.e. almost vazotonicheskih massage (Petrevski AV, Gundogan I.A., 1994). Simultaneously, it was observed biomicroscopic expressed local hyperemia noticeable expansion of the artery, exposed Westonaria. Thus, temporary occlusion of the vessel caused the development of reactive Hyper in it, and after that there was hyperperfusion structur PSG krovosnabjaemah subjected to massage the OCA. When this blood flow is restored to the off from it due to hypotension in the OCA fragments capillary level of the microvasculature, which was confirmed data biomicroscopy bulbar conjunctiva and limbus, where during vazotonicheskih massage intensified blood flow in the capillary bed and opened "new" capillaries.

Identification of the vessel for vazotonicheskih massage in the proposed method is not difficult and requires no special tests, because episcleral location OCA easily accessible biomicroscopic imaging and various effects, including compression. This anatomical and functional feature allows you to easily terminate or repeat the procedure.

Pathogenetically data selection of vessels for vazotonicheskih massage due to the fact that PSG are 2 important structure is the target of glaucoma process: the ciliary body, secreting intraocular fluid, and drainage area, providing the outflow. From literature data it is known that hemochromatosis disorders in primary open-angle glaucoma is chinautla it in PSG, and the deficit of blood supply leads to the development of degenerative processes in the corneoscleral trabecular, reducing the outflow chamber moisture (Larina ST, 1977; Fedorov, S., 1981). One of the quantitative evidence of inadequate blood supply in PSG is hypotension in the OCA (Petrevski A.V. et al., 2004).

An example of the proposed method. After the examination, including tonography, computerized static perimetry and Westonaria in the OCA with the calculation of perfusion pressure in the PSG by a known method (Petrevski A.V. et al., 2004), the patient was administered instillation of azopt 1 or 2 times a day. A day after the beginning of drug treatment was started daily vazotonicheskih massage, the average duration of a single session which was 5 minutes. Before performing the exposure was carried out epibulbar anesthesia using anesthetic (dikain or inocian). Vazotonicheskih massage was transconjunctival impact in the projection of the tendon attachment of direct muscles, and also in the projection of the vessel, reaching episcleral to emissary along the length thereof, through repeated alternation of mechanical compression and ascend, the Deco. Massage the OCA was carried out using the device, structurally mimic the working part of Wattenmeer our modification (Gundogan I.A., Petrevski A. is., 1997) and represents a metal rod-holder, curved at an angle of 150° and rigidly connected by means of a metal bezel with a microlens made of organic glass, which is in the geometric form of a cylinder of base diameter 5 mm and height 1 mm (innovations, Volga No. 21 from 20.10.03). Massage in the projection of direct tendon of the muscle was carried out by the flat part of the glass sticks laying ointment. Was massaged mainly the upper and lower trunk OCA. When well-marked lateral and medial branches of the massage was exposed and they. The pressure in the OCA was additionally measured before each subsequent procedure.

The treatment was performed in 19 patients with primary open angle glaucoma with normal intraocular pressure (up to 27 mm Hg)treated with azopt as monotherapy once or twice a day.

Treatment consisted of 10 sessions vazotonicheskih massage on the background of receipt of azopt. Upon completion of the course of treatment was performed control tests (tonography, perimetry, Westonaria in the OCA). Comparative data before and after treatment are given in the table.

Table
Hydrodynamic, hemodynamic and functional results of complex treatment in patients with primary drytooling glaucoma, M±m
IndicatorsBefore the treatmentAfter the treatment
IOP, mm Hg23,6±2,515,2±1,9
The pressure in the OCA, mm Hg62,74±3,3868,52±2,84
Perfusion pressure, mm Hg41,30±3,152,0±1,80
The number of cattle absolute17±2,56±0,4

At the end of treatment was achieved correction of hypotension in the OCA and hypogeophis in PSG (table). Positive dynamics in the changes field of view in the form of reducing the absolute number of animals. Pathogenetic orientation, simplicity and security of the proposed method allow for repeated courses of treatment and to achieve stabilization of the glaucomatous process in patients with primary open-angle glaucoma.

LITERATURE:

1. Beksinski P.P. Effect of conservative therapy and surgical treatment on regional hemodynamics in eyes with primary open-angle glaucoma: author. Diss. Kida. the honey. Sciences. - M., 2000. - 20 S.

2. Bunin YA, Fly A.I., kolomoitseva H. Perfusion pressure in the blood vessels of the eye in patients with open-angle glaucoma.//Vestn. of ophthalmology. - 1995. - T, No. 1. - P.28-31.

3. Gundogan I.A., Petrevski Aviprocessortrial Wattenmeer for measuring the pressure in the anterior ciliary vessels.//The manuscript, Dept. in GCNM. No. 25.402. - M., 1997. - 4 S.

4. Krasnov, M.M. analysis of the characteristics of ocular hemodynamics and therapeutic effect on her glaucoma and blood circulation deficiency.//Journal of ophthalmology. - 1989. No. 6. - P.36-43.

5. Larina ST Morphology of the blood vessels of the sclera for glaucoma./Physiology and pathology of intraocular pressure: proceedings of the Moscow State. the honey. in-TA them. N.I.Pirogov. - M., 1977. - P.35-38.

6. Petrevski AV, Gundogan I. Methodological aspects of Westonaria in episcleral vessels.//Abstracts of the 49th scientific session of the Volgograd honey. Academy. - Volgograd, 1994. - P.39-40.

7. Petrevski AV, Gundogan I.A., Mansur I.D. State perfusion of the anterior segment of the eye in patients with primary open-angle glaucoma.//Glaucoma. - 2004. No. 1 - P.18-23.

8. Petrevski AV, Ballin SV, ALEXANDER Gushchin, Mansur I.D. clinical Experience of azopt in the treatment of primary open-angle glaucoma.//Modern methods of treatment in ophthalmology: Sborn. the scientific. articles. - Nalchik, 2002. - S-99.

9. Fedorov SN. The pathogenesis of primary open-angle glaucoma.//Issues of pathogenesis and treatment of glaucoma: Sborn. the scientific. proceedings of the IRI. - M., 1981. - P.3-7.

10. Hayreh SS, Scott W.E. iris Fluorescein angiography. I. Normal pattern//Arch. Ophthalmol. - 1978. - Vol.96, No. 8. - P.1383-1389.

11. Hayreh SS, Scott W.E. iris Fluorescein angiography. II. Disturbances in iris circulation following strabismus operation on various recti.//Arch. Ophthalmol. - 1978. - Vol.96, No.. - P.1390-1400.

12. Lobstein, A., Herr F. L ophthalmodynamometrie dans le glaucoma.//Ann. Oculist. - 1966. - Vol.199. - P.38-69.

A method of treating primary open-angle glaucoma by instillation inhibitor carbohydrase of azopt, characterized in that through the day after the start of medication in the background get azopt exercise vazotonicheskih massage anterior ciliary arteries (OCA) - transconjunctival impact on the OCA through repeated alternation of mechanical compression and decompression using Wattenmeer.



 

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