Structural-functional and hemodynamic features of simple primary and pseudoexfoliation open-angle glaucoma and ophthalmic hypertension
D.A. DOROFEEV1, V.F. EKGARDT2
1Public Clinical Hospital №2, 82 Lenin Ave., Chelyabinsk, Russian Federation, 454080
2South Ural State Medical University, 64 Vorovskogo Str., Chelyabinsk, Russian Federation, 454092
Dorofeev D.A. — ophthalmologist, tel. (351) 776-90-54, e-mail: dimmm.83@gmail.com
Ekgardt V.F. — D. Sc. (medicine), Professor of the Eye Diseases Department, tel. (351) 210-00-31, e-mail: valeriy.ekgardt@mail.ru
Objective ― to assess the features of regional hemodynamics depending on the structural and functional characteristics of the visual analyzer in patients with POAG, PEG (and on the paired eye without glaucoma), OH in comparison with the control group, using an ultrasound device of general use with standard sensors.
Methods. The work was carried out from 2011 to July 2017. The data of the analytical, observational case-control study were analyzed. There were 1370 patients under observation, according to inclusion and non-inclusion criteria; 290 patients (540 eyes) with POAG, PEG, ophthalmic hypertension (OH) and healthy people became the subject of the study. At the time of enrollment, all patients underwent visometry, tonometry, elastotonometry (five times in 3 months, the mean value was used for the calculations), computerized perimetery, optical coherence tomography of the macular zone and optic nerve disk, pachymetry (Spectralis OCT, Heidelberg Engineering, Germany), keratorefractometry, ultrasound dopplerography (USDG) of the orbital vessels, with the measurement of IOP and blood pressure (BP) just before the USDG, using Toshiba Aplio XG general-purpose device with a line sensor 5-12 MHz with a standard program for small organs.
Results. Hemodynamics of the CRA: the speed characteristics of Vmax were statistically different in the OH groups (11.8 (9.5; 14.3); 12.1±3.5) and Normal (10.0 (8.3; 11.9); 10.5±3.0), as well as PEG (10.9 (9.2; 13.0); 11.4±3.7) and unilateral PEG (11.8 (8.7; 13.9); 11.7±3.9). In addition, when analyzing the hemodynamic parameters of the choroid, changes similar to CRA were detected; there is a tendency to increase Vmax at OH and unilateral PEG.
Conclusion. Under conditions threatening with glaucoma, choroid OH and unilateral PEG, the rate of blood flow in the CRA can act as a predictor of the transition from a healthy state to glaucoma, and can be considered as a compensatory mechanism that prevents the development of glaucoma.
Based on the obtained results, a glaucoma probability calculator was created on 15 predictors, chosen by the regression model https://sites.google.com/view/glaucomacalc.
Key words: glaucoma, pseudoexfoliation glaucoma, level of intraocular pressure, USDG.
(For citation: Dorofeev D.A., Ekgardt V.F. Structural-functional and hemodynamic features of simple primary and pseudoexfoliation open-angle glaucoma and ophthalmic hypertension. Practical Medicine. 2018)
REFERENCES
- Abysheva L.D., Avdeev R.V., Aleksandrov A.S. et al. Optimal characteristics of the upper border of the ophthalmotonus in patients with advanced stage of primary open-angle glaucoma in terms of evidence-based medicine. Novosti glaukomy, 2016, no. 1, pp. 61-71 (in Russ.).
- Avdeev R.V., Aleksandrov A.S., Bakunina N.A. et al. Clinical and mathematical model of primary open-angle glaucoma manifestation and outcomes. Novosti glaukomy, 2015, no. 1, pp. 55-63 (in Russ.).
- Kuroedov A.V., Abysheva L.D., Aleksandrov A.S. et al. Tactics of management of patients with primary open-angle glaucoma in practice: variants of drug, laser and surgical treatment. Mediko-biologicheskie problemy zhiznedeyatel’nosti, 2016, vol. 15, no. 1, pp. 170-185 (in Russ.).
- Onufriychuk O.N., Avdeev R.V., Aleksandrov A.S. et al. Morphofunctional changes in the macular area of the retina in the «dry» form of age-related macular degeneration (review). RMZh “Klinicheskaya Oftal’mologiya”, 2013, vol. 14, no. 3, pp. 123-130 (in Russ.).
- Baranov V.I., Brezhnev A.Yu. Pseudoexfoliation syndrome in Central Russia: clinical and epidemiological study. Rossiyskiy oftal’mologicheskiy zhurnal, 2012, vol. 5, no. 1, pp. 22-24 (in Russ.).
- Cahill M., Early A., Stack S. et al. Pseudoexfoliation and sensorineural hearing loss. Eye (London, England), 2002, no. 3 (16), pp. 261-6.
- Hollo G. Exfoliation syndrome and systemic cardiovascular diseases. Journal of glaucoma, 2014, no. 8, suppl. 1 (23), pp. S9-11.
- Schlötzer-Schrehardt U., Gottfried O.H.N. Ocular and Systemic Pseudoexfoliation Syndrome. American Journal of Ophthalmology, 2006, no. 5 (141), pp. 921-937.e2.
- Ekgardt V.F., Dorofeev D.A. The hypotensive effect of prostaglandin analogs in the treatment of simple and pseudoexfoliative open-angle glaucoma. Otrazhenie, 2017, vol. 1, no. 1, pp. 40-46 (in Russ.).
- Ekgardt V.F., Dorofeev D.A. Opportunities of starting therapy of simple and pseudoexfoliative open-angle glaucoma with analogues of prostaglandins in advanced stages of the disease. Natsional’nyy zhurnal glaukoma, 2017, vol. 16, no. 1, pp. 28-37 (in Russ.).
- Ekgardt V.F., Dorofeev D.A., Shaimov T.B., Deev R.V. On the size of the optic nerve disk. Kazanskiy meditsinskiy zhurnal, 2013, vol. 94, no. 6, pp. 850-853 (in Russ.).
- Dorofeev D.A., Ekgardt V.F., Shaimov T.B., Deev R.V. A Tale of the size of the optic nerve disk. Vestnik Soveta molodykh uchenykh i spetsialistov Chelyabinskoy oblasti, 2014, no. 1-2, pp. 36-40 (in Russ.).