Normal tension glaucoma was isolated as a separate clinical form of primary open-angle glaucoma at the end of the 20th century. In the article, various points of view on the development of this most difficultly diagnosed variety of glaucoma, as well as modern concepts of the pathogenesis of normal tension glaucoma which determine the strategy of a new approach to its diagnosis, are reviewed in the historical aspect.
Введение. Исследование факторов, способствующих нарушению трансмембранного градиента давления, является актуальной задачей в изучении патогенеза глаукомы нормального давления (ГНД). Цель исследования-измерить и сравнить толщину и глубину решетчатой пластинки (РПТ и РПГ) склеры, ширину субарахноидального пространства зрительного нерва (ЗНСАПШ) у больных с ГНД и здоровых лиц. Материал и методы. В 1-ю группу включили 12 больных (23 глаза) с ГНД в возрасте от 58 до 74 лет (66,8±3,2), все они имели нормальное внутриглазное давление и артериальную гипотензию; 2-ю (контрольную) группу составили 11 здоровых человек (22 глаза) в возрасте от 51 до 69 лет (56,8±4,2). Всем больным с ГНД выполняли структурно-функциональную оценку диска зрительного нерва с помощью OCT RTVue-100 (Optovue, США), периметра Humphrey (HFA II 745i, Германия-США) и нашей модификации периметрии с удвоением пространственной частоты. Всем испытуемым центральную толщину роговицы (ЦТР) измеряли с помощью Pentacam HR (Oculus, Германия), РПТ и РПГ-с помощью Topcon 3D OCT 2000 (Япония) в режиме увеличенной глубины изображения (EDI). Для измерения ЗНСАПШ использовали снимок поперечного среза ЗН, выполненного в 3 мм за глазом с помощью магнитно-резонансного томографа (Siemens Magnetom Symphony 1,5 Тл, Германия). Результаты. В 1-й и 2-й группе различие между средними значениями РПТ (217,60±36,92 и 345,86±33,29 мкм соответственно; p=0,0000), РПГ (435,00±86,31 и 367,31±87,00 мкм соответственно; p=0,014) и ЗНСАПШ (1,27±0,13 и 1,44±0,19 мм соответственно; p=0,004) было значимое, а между средними значениями ЦТР (543,26±31,52 и 557,50±24,92 мкм соответственно)-незначимое (p=0,101). Заключение. У больных с ГНД величина РПГ при достоверно меньших значениях РПТ и ЗНСАПШ была достоверно больше, чем у здоровых лиц, что подтверждает значимость этих морфометрических критериев для изучения патогенеза ГНД. Ключевые слова: патогенез глаукомы нормального давления, центральная толщина роговицы, толщина решетчатой пластинки, глубина решетчатой пластинки, ширина субарахноидального пространства зрительного нерва.
Purpose. To assess the possibility of using intrastromal keratoplasty with intracorneal ring segments implantation as an independent technique to achieve visual rehabilitation in patients with keratoconus of the stages I and II. Material and methods. There were examined and operated 14 eyes (10 patients) with keratoconus of the stages I and II (classification by Izmailova SB, 2014). Patients were divided into two groups depending on the keratoconus stage. All patients underwent intrastromal keratoplasty with intracorneal ring segments implantation using the femtosecond technology. The on average follow-up was 5.7 months. Results. In the first group: the average UCVA value increased with from 0.31±0.21 to 0.81±0.31 (p<0.05); the BCVA increased from 0.89±0.08 to 0.94±0.10 (p>0.05); the spherical component of refraction decreased from 0.96±1.25 to 0.08±0.20 (p<0.05); the cylindrical component of refraction decreased from 4.25±1.73 to 0.50±1.22 (p<0.05). In the second group: UCVA increased from 0.51±0.40 to 0.61±0.28 (p<0.05); the BCVA increased from 0.70±0.17 to 0.81±0.26 (p>0.05); the spherical component of refraction decreased from 4.88±2,61±0.53±0.63 (p<0.05); the cylindrical component of refraction decreased from 2.69±1.65 to 1.41±1.02 (p<0.05). Conclusion. 1. After implantation of intracorneal ring segments, both in patients with I and in patients with the II stage of keratoconus, there was an increase in the UCVA and BCVA, as well as a significant reduction in maximal keratometry and coma, which provides the improving of the quality of vision. 2. In all cases the UCVA and BCVA that were obtained after the treatment reached a sufficiently high level to ensure the possibility of performing their professional functions, without resorting to additional surgical treatment techniques. That characterizes this method as an independent and sufficient to achieve high visual acuity in patients with I and II stages of keratoconus. Key words: keratoconus, corneal intrastromal segments, femtosecond laser, visual rehabilitation.
PURPOSE:To measure lamina cribrosa thickness (LCT) and lamina cribrosa depth (LCD), optic nerve subarachnoid space width (ONSASW) in patients with normal tension glaucoma and in healthy individuals and to compare these data with the results of our own pilot study. MATERIALS AND METHODS:The 1st group included 13 patients (22 eyes) with normal tension glaucoma aged 39 to 88 years (59.8 10.9 years). The 2nd (control) group included 10 healthy people (20 eyes) aged 40 to 59 years (47.9 5.5 years). All subjects underwent structural and functional assessment of the optic nerve head using optical coherent tomograph (OCT) RTVue-100 (Optovue, USA), Humphrey perimeter (HFA II 745i, Germany-USA), and our own modification of Frequency Doubling Technology perimetry. LCT and LCD were measured by OCT RS-3000 Advance (Nidek, Japan). To measure ONSASW we used a cross-sectional image of the optic nerve taken with Magnetic Resonance Imaging (GE Optima MR450w MRI, USA). RESULTS:Differences in the 1st and 2nd groups between the mean values of LCT (234.14 27.73 and 336.25 21.0 m, respectively;p= 0.0000), LCD (461.8 101.7 and 361.65 58.2 m, respectively;p= 0.0004) and ONSASW (1.371 0.035 and 1.52 0.133 mm, respectively;p= 0.011) were statistically significant. CONCLUSION:Patients with normal tension glaucoma had significantly higher LCD value with significantly lower LCT and ONSASW values compared to healthy individuals, which is comparable with the results of our pilot study, and confirms the importance of these morphometric criteria in normal tension glaucoma diagnosis verification.
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