Personalized medicine in glaucoma management

Журавлева, А. Н.; Киселева, О. А.; Кириллова, М. О.

doi:10.21516/2072-0076-2019-12-3-95-100

Cited by 6 publications

(1 citation statement)

References 39 publications

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“…Факторами риска ГОН принято считать: возраст, семейный анамнез, повышенное внутриглазное давление, миопию, расовую принадлежность, системные нарушения [2,3]. Несмотря на возможности современных измерительных приборов, чувствительность определяющих постановку диагноза критериев высока только в том случае, когда заболевание уже находится в своем развитии [4]. Так, чувствительность стандартной автоматизированной периметрии (SAP, или САП) и технологии удвоения частот (FDT-периметрии) составляет в среднем 74-76 и 96 % соответственно.…”

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Electrophysiological markers of preclinical diagnosis of glaucomatous optic neuropathy

Кириллова

Цапенко

et al. 2021

Rossijskij oftalʹmologičeskij žurnal

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Purpose: to evaluate the changes in electrophysiological indicators reflecting various aspects of the function of retinal ganglion cells (RGC) and their axons in the early diagnosis of glaucomatous optic neuropathy (GON).Material and methods. Two clinical groups, (1) 35 patients (60 eyes) aged 49 to 70 with suspected glaucoma and (2) 16 patients (30 eyes) aged 43–68 with initial primary open-angle glaucoma (POAG), and a comparison group of 38 relatively healthy subjects (45 eyes) aged 42–70 were tested for pattern-reversed visual evoked potentials (PVEP), transient and stationary pattern-ERGs (PERG) according to ISCEV, and photopic negative response (PhNR).Results. The P100 amplitudes in both clinical groups differed significantly from the norm in PVEP on small and large patterns. The elongation of peak latency (T) of P100 compared with norm was significant for the stimulus 1° in group 2. In both groups of patients, increased variability of the temporal parameters of PERG and PVEP for small patterns was found. In groups 1 and 2, a decrease in the amplitude of P50 and N95 peaks of transient PERG for all stimuli was revealed, which was the most significant for the 0.3° pattern. In group 1, the N95 peak was significantly delayed in PERG for large patterns. A statistically significant reduction in the steady-state PERG's amplitude was found in the groups of suspected glaucoma and initial POAG. The sharpest changes were found for small (0.8° and 0.3°) patterns. The elongation of T compared to the norm was most pronounced for PERG at 0.3°, but due to the high variability of temporary indicators within the group, it had no statistical significance. The amplitude of PhNR was significantly different from the norm in the ERG for a flash of 3.0 cd·sec/m2.Conclusion. In patients with suspected glaucoma, a decrease in the P100 VEP amplitude with the simultaneous elongation of T may be considered as a criteria for the plastic stage at the level of lateral geniculate nucleus. Markers of functional changes in RGCs are the decrease in the amplitude of PhNR in response to bright flash, and P50 and N95 of PERG for pattern size 0.3°. The results indicate a greater vulnerability of the parvocellular system to early events in the development of GON.

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Electrophysiological markers of preclinical diagnosis of glaucomatous optic neuropathy

Кириллова

Цапенко

et al. 2021

Rossijskij oftalʹmologičeskij žurnal

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The role of genetic factors in the pathogenesis of primary open-angle glaucoma. Part 1. Connective tissue

Журавлева

Николаевна²,

Кириллова

et al. 2021

Ophthalmology Reports

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The article presents an analytical review of works devoted to molecular and genetic studies in primary open-angle glaucoma from the perspective of the concept of hereditary inferiority of the connective tissue of the eye (scleral component), and the entire body as a whole, as triggers in the development of the disease. The relationship between the main theories of the pathogenesis of glaucoma optical neuropathy and the determining role of molecular and genetic mechanisms of specific changes in the eye tissue is shown. The clinical features of primary open-angle glaucoma in patients with a family history are analyzed. Potentially new directions for preclinical diagnosis of glaucoma and pathogenetically oriented therapy are proposed.

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Optimization of Medicinal Treatment of Patients with Glaucoma in Combination with Concurrent System Pathology. Part 1: Cardiovascular Pathology

Журавлева

Шустов

2020

Oftalʹmologiâ

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This paper presents clinical and pharmacological drug interactions for the treatment of patients with glaucoma combined with concurrent cardiovascular pathology, risks of side effects, and adverse drug reactions. The article discusses the multifactor nature of glaucoma, age factors, and the direction of local and systemic pathogenetic treatment, principles of the personified approach, and its feasibility. It is shown that an essential element of this approach can be a system of questionnaires for glaucoma patients with chronic diseases, the principal place in which is occupied by a questionnaire filled out by the patient himself. Digital processing of individual data and assessments provided by patients allows us to implement the tasks of a personalized approach to the treatment. Analysis of the pharmacological effects of the available and used arsenal of medicinal products allows you to generalize the array of data obtained, to form model algorithms for deciding by an ophthalmologist on the choice of medications. In scheme optimizing of the prescribed medications, it is important to cross-inform between specialists of different profiles (ophthalmologists, therapists, neurologists, cardiologists, endocrinologists, rheumatologists, etc.), create an algorithm for entering the medications of choice and their rational combinations, which reduces the risk of polypragmasia. Possible causes of progression of glaucoma optic neuropathy (GON) against the background of age-related systemic diseases (using the example of the cardiovascular system’s pathology) are considered. Ways of influencing the pathogenetic links of the glaucomatous process are proposed from the standpoint of an optimal combination of medications. Analysis of literature on the problem of structural and functional disorders in GON’s development shows that it is promising to expand our understanding of the fundamental processes underlying these changes, search for clinically significant combinations of contemporary markers of changes in structure and function, and, accordingly, treatment approaches. The possibilities of neuroprotection of glaucoma optical neuropathy, as well as modern methods of electrophysiological research in the monitoring assessment of its effectiveness and the differential diagnosis, approaches to enhance the effectiveness of medications treatment with combined medications are analyzed in the article.

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Personalized medicine in glaucoma management

Cited by 6 publications

References 39 publications

Electrophysiological markers of preclinical diagnosis of glaucomatous optic neuropathy

Electrophysiological markers of preclinical diagnosis of glaucomatous optic neuropathy

The role of genetic factors in the pathogenesis of primary open-angle glaucoma. Part 1. Connective tissue

Optimization of Medicinal Treatment of Patients with Glaucoma in Combination with Concurrent System Pathology. Part 1: Cardiovascular Pathology

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