Terminal (absolute) glaucoma is the last stage of such a widespread disease today as glaucoma, accompanied by irreversible consequences in all parts of the eyeball and complete atrophy of the optic nerve, leading to blindness.
The degree of the disease is determined by the condition of the anterior ciliary vessels and the level of intraocular pressure. When the disease is just beginning to develop, ocular pressure readings usually do not exceed 28 mm Hg. Pressure above this indicator leads to vasodilation of the eye, edema of the cornea and eye tissues. Constantly high pressure disrupts the normal functioning and metabolism of the eye tissues, leading subsequently to irreversible changes in visual function.
Absolute glaucoma is accompanied by severe pain, damage to the cornea, incorrect perception of light perception, internal tears, thinning and stretching of the posterior and anterior ocular regions, concomitant infectious diseases of the eyes, and often has an unfavorable outcome. In the event of a perforation of the ocular cornea, there is a rupture of the posterior arteries and the expulsion of the membranes of the eye from the eyeball during high ocular pressure.
Absolute glaucoma has pronounced symptoms, including:
- severe pain and pain of the cornea, lasting for a long time;
- change in the appearance of the eye (it takes on a stony appearance);
- lack of reaction to the perception of light by the pupils;
- pronounced discharge of fluid from the eyes;
- complete lack of vision;
- increased intraocular pressure;
- compression of the optic nerve fibers;
- poor oxygen supply to the cells of the eye;
- decreased blood circulation in the eye tissues;
- malnutrition and destruction of optic fibers;
- optic nerve atrophy.
Clinical manifestations of absolute glaucoma in adults
In case of absolute glaucoma, the blind eye can look like a healthy eye for a long time and not cause discomfort in the patient.
Later, complications may arise, for example, glaucomatous cataract that cannot be operated on, corneal ulcers, dystrophic keratitis. Sometimes complications may not arise immediately, but slowly progress for some time, after which the eyes suddenly turn red (as if bloodshot), severe pain occurs, and a sharp deterioration in the patient's health is observed.
There are cases when partial atrophy of the optic fibers occurs. In such cases, patients have a chance of successful treatment, which consists in partial restoration of vision.
The importance of timely diagnosis of the disease
Early diagnosis of the disease is very important because in some cases, surgery in advanced or advanced stages does not guarantee even partial restoration of vision.
Since absolute glaucoma develops imperceptibly, often without pronounced symptoms, it is very difficult to detect it in a timely manner, even for experienced specialists. Therefore, the manifestation of even the smallest symptoms, such as discomfort, dryness, stinging, pain in the eyes, is a reason to consult a doctor for examination.
Methods of conservative and surgical treatment
For severe eye pains accompanied by loss of vision, the following treatment methods are used:
- X-ray therapy;
- neurectomy;
- treatment with retrobulbar injection of chlorpromazine or alcohol into the eyeball;
- in rare cases, removal of the eye.
With absolute glaucoma, vision is zero. The assessment of visual function is determined by the degree of compensation of the stage of the disease by the doctor during the measurement of the level of intraocular pressure and the assessment of the state of the anterior ciliary vessels. The decompensated stage of the disease is one hundred percent absolute glaucoma.
After unsuccessful conservative treatment, the most effective method of getting rid of absolute glaucoma is considered to be an operation, during which severe pains caused by degenerative changes in nerve endings are eliminated.
Basically, surgical treatment is aimed at lowering intraocular pressure, reducing the pain threshold, and preserving the blind eye. With absolute glaucoma, constantly accompanied by severe inflammation and pain, an operation to remove the eyes is required. The prognosis in this case is unfavorable, because restoration of visual functions is no longer possible.
It is very important that the operations of diathermocoagulation of the ciliary nerves and ciliarotomy in the treatment of absolute glaucoma go without complications (there are cases of transection during the operation of the optic nerve), because this is most beneficial for relieving pain and restoring the cornea of the eye. Both operations are technically difficult, but not dangerous. Postoperative recovery occurs very quickly.
When there is no way to save the eyes, an operation is performed to remove the eyeballs, after which intraocular prosthetics are performed for cosmetic purposes.
Complications after surgery
Professional ophthalmologists are increasingly talking about the ineffectiveness of carrying out routine operations for patients with glaucoma, explaining this by various complications, among which are widespread:
- frequent heavy eye bleeding;
- the inability to reduce intraocular pressure;
- gaping wound;
- increased pain.
Today, as long-term world practice shows, the best option for ophthalmic surgery for terminal glaucoma is opticociliary neurectomy. This is a technically simple operation that allows you to quickly eliminate pain, normalize intraocular pressure, and, most importantly, preserve the eye as a cosmetic organ.
Undoubtedly, there are also contraindications to oticociliary neurectomy, which include:
- advanced degenerative changes in the cornea;
- oncology of the organs of vision;
- very high intraocular pressure, which can be fatal during surgery;
- severe preoperative condition of the patient.
Opticociliary neurectomy should be used very carefully as a method of surgical treatment for trophic changes in the cornea in order to avoid the risk of an adverse outcome.
Is there a threat of miscarriage in case of absolute glaucoma?
Absolute glaucoma does not adversely affect the process of conception and bearing of the fetus. According to the results of some studies carried out in Europe, in a certain percentage of women with pathology of absolute glaucoma, on the contrary, pregnancy contributed to the normalization of eye pressure.
Basically, the drugs that the woman takes during treatment have a negative effect on the development of the fetus. Some of the drug components pass into breast milk, harming the baby.
Causes of absolute glaucoma in children
Every year, more and more cases of diagnosing terminal glaucoma in children.
Absolute glaucoma in children occurs due to:
- genetic predisposition to the disease;
- intrauterine fetal developmental disorders;
- the influence of certain factors (drugs, drugs, alcohol) on the fetus during pregnancy;
- transferred viral infections of a pregnant woman (influenza, rubella, toxoplasmosis, syphilis, measles, etc.);
- pathologies of the nervous, cardiovascular and endocrine systems of the fetus;
- fetal hypoxia during childbirth;
- mechanical injuries of a pregnant woman;
- intoxication, maternal vitamin deficiency;
- abnormal intrauterine development of the eyeballs of the fetus.
This condition is rare in infants. If it occurs, it is much easier to stop the development process and operate on a child in time than on an adult. Postoperative treatment in 94% of cases gives the child a chance to see normally. In order not to miss the opportunity to restore the full-fledged vision of the baby, it is important to diagnose this disease in time.
Signs of absolute glaucoma in children
Very often it is possible to diagnose absolute glaucoma in infants according to certain symptoms, and in older children - according to certain behavioral characteristics, among which are:
- restless behavior of the child;
- a sharp decrease in appetite;
- restless sleep of newborns;
- fear of light perception;
- complaints of poor eyesight;
- persistent redness of the eyes;
- dilated pupils;
- changes in the structure of the cornea;
- dilated vessels of the sclera;
- pain and pain in the eyes;
- change in the shade of the sclera;
- frequent lacrimation and blinking.
Usually, in the initial stage, the disease proceeds without any symptoms, therefore, in order not to miss the onset of glaucoma, it is recommended that parents visit a pediatrician every month during the first year of a baby's life.
Methods for the diagnosis of absolute glaucoma in children
Absolute glaucoma is most often diagnosed during the examination of the child by a pediatrician or ophthalmologist, less often by a geneticist. During the examination, the causes and stage of the disease are established, the most effective treatment options are selected. At the first stages of the disease, the symptoms of absolute glaucoma are similar to conjunctivitis, therefore, to clarify the diagnosis, it is imperative to measure the intraocular pressure and thoroughly examine the cornea.
In the treatment of absolute glaucoma in children, both medical and surgical treatment are used.
Medical treatment is the instillation of eye drops in newborns to normalize intraocular pressure. But it is not effective for restoring normal vision function, therefore, if there are no contraindications, an operation is necessary, the purpose of which is to reduce pressure by increasing the outflow of fluid from the eye. The effectiveness of the operation depends on the stage of the disease, the presence or absence of concomitant eye diseases and the age of the child.
Postoperative treatment includes additional drug therapy for the fastest recovery. If the first performed operation did not give positive results, it is necessary to carry out the second operation. It is important to carry it out as early as possible, since absolute glaucoma develops very quickly in childhood.
It is best to measure intraocular pressure in newborns during normal sleep, using additional sleeping pills or anesthesia.
Due to the rapid progression of the disease in infancy and in order to increase the child's chances of maintaining normal vision in the future, any manifestations of glaucoma should be diagnosed as early as possible and their treatment should be started at the initial stage.
The diagnosis of absolute glaucoma in children is not a sentence to remain blind for life. Modern microsurgical ophthalmology allows you to stop the development of the disease, and in case of timely diagnosis, completely restore vision.
A serious ophthalmic condition that leads to complete loss of vision in the last stage is called terminal glaucoma. With the development of the clinical picture, it is worthwhile to immediately consult a doctor, since delaying treatment can provoke persistent severe pain, blindness, or excision of an atrophied organ.
The causes of the development of the disease
Absolute painful glaucoma gets its name from the persistent pain that cannot be stopped, as well as the developing blindness. The disease is formed under the influence of a number of factors, which together trigger the pathological process. The main reasons include:
- heredity;
- heart diseases;
- a sharp increase in blood pressure;
- endocrine and nervous system disorders;
- anomalies of the eyeball;
- late started therapy;
- wrong treatment method.
Symptoms characterizing the deviation
This type of glaucoma is characterized by pain that spreads to the face and head.
Each ailment has a characteristic clinical picture, which depends on the stage of development. Terminal glaucoma is characterized by the following manifestations:
- sharp, intolerable pain syndrome;
- projecting pain on the face and head;
- narrow palpebral fissure;
- excavation of the optic nerve head;
- lack of pupil response;
- dystrophic changes in the iris;
- the level of eye pressure is 50-60 mm Hg. Art.
- lightheadedness;
- atrophy of nerve endings;
- swelling of the cornea;
- complete loss of vision.
How is the diagnosis carried out?
If warning signs appear, you should seek help from the hospital. First, you should visit a therapist who will issue a medical record. After that, the patient will be sent for consultation to a narrow-profile specialist, namely an ophthalmologist. He will conduct an initial examination, make an anamnesis, measure pressure readings. After that, auxiliary studies are written out that will help establish the scale of destructive changes. These include:
Additional examinations will give complete information about the disease. - tonometry;
- perimetry;
- Heidelberg retinotomography;
- scanning polarimetry.
How is the disease treated?
Features of the drug method
If the pain in the eyeball is not very pronounced, then drug therapy is the first step in the fight against absolute glaucoma. The main groups of drugs include:
| Group | A drug | Action |
| Cholinomimetics | "Pilocarpine" | Helps restore the outflow of ocular fluid |
| "Karbakhol" | ||
| Sympathomimetics | "Glauconite" | Effectively affect eye pressure, prevent duct blockage |
| Epinephrine | ||
| "Clonidine" | ||
| Prostagladins | "Travoprost" | Interact with receptors in the ciliary body, minimize the effect on the pupil and improve lacrimal drainage |
| "Tafluprost" | ||
| Latanoprost | ||
| Adrenergic blockers | "Arutimol" | Control the level of moisture in the eyes, reduce the level of pressure |
| Okumed | ||
| Carbonic anhydrase inhibitors | "Azopt" | Works with an enzyme produced by the ciliary body of the eyeball |
| "Trusopt" | ||
| Combined funds | "Cosopt" | The complex effect increases the therapeutic effect and reduces the level of pressure, lacrimation |
| "Xalakom" | ||
| "Azarga" |
When is the operative treatment of the disease carried out?
Laser treatment has a number of advantages over conventional surgery. Laser intervention is considered the most popular method for treating terminal painful glaucoma when medications are useless. This approach avoids cutting the eye wall, is painless and instant. The main surgical procedures include:
- Traction. The laser coagulant acts in the area of the trabecula of the anterior chambers of the eyes. This allows you to restore the outflow of intraocular fluid.
- Transscleral. Some of the eyelashes are thermally removed, which significantly reduces tearing and pressure in the eye.
- Iridotomy. It acts as an additional method, which is carried out after intraocular surgery. This intervention has strict contraindications, such as swelling, small anterior chamber.
- Irido- and papilloplasty. The edges of the iris are covered with lightweight coagulants, which makes it possible to expand the anterior angle of the ophthalmic chamber.
- Removal of the eye. When organ-preserving surgeries are ineffective, doctors are forced to excise the affected organ.
Techniques are selected based on the results of the examinations and are carried out strictly under the supervision of a physician.
Absolute (terminal) glaucoma is the final stage of chronically increased intraocular pressure, characterized by buphthalmos, severe degenerative changes in most eye tissues, blindness and severe pain syndrome. Although animals with this pathology often do not exhibit painful reactions to palpation, observations by Magrane (1965) and confirmed by many clients show that enucleation of the affected eye usually leads to an improvement in the animal's condition, playfulness and temperament, which leaves no doubt is that such eyes are a source of intense physical distress for most dogs and cats.
Unfortunately, glaucoma is common in dogs, which is associated with the following factors:
Pet owners often overlook the disease early on.
- Incorrect or insufficient early diagnosis or untimely or ineffective treatment was carried out.
- Weak sensitivity of dogs and cats to therapeutic or surgical treatment of glaucoma.
In the absence of treatment at the buphthalmos stage, the end result of the process is corneal degeneration and ulceration with possible subsequent rupture of the cornea, which makes the need for enucleation irreversible. This is the result of loss of sensation in the central cornea, lagophthalmos and drying out of the cornea, degenerative keratitis, and trauma from bulging of the eyeball. The time interval until the final corneal rupture is unpredictable, with only a minimal number of patients achieving a stable, painless, albeit ugly, eye condition.
Pathological effects of chronically elevated IOP on eye tissue
In chronic glaucoma, most eye tissues are affected. Vision is most severely damaged by damage to the optic nerve and retina.
Optic nerve: Dramatically and irreversibly affected in the area of the optic nerve head, which becomes crater-shaped or cupped. Initially, the tissues in front of the scleral ethmoid plate are compressed. Increased IOP compresses and deforms the ethmoid plate of the sclera and disrupts the blood supply to the optic nerve head. This process mechanically interrupts the normal posterior axoplasmic current and ischemia of axons exiting the optic nerve head. This axoplasmic current normally flows from the bodies of ganglion cells lying in the layer of ganglion cells of the retina towards the dendrites of cells located in the lateral geniculate bodies. Ultimately, axon atrophy occurs and the pressure bends the cribriform plate outward. This is followed by secondary degeneration of the ascending nerve fibers. A crater-like deformity of the optic nerve head can be seen ophthalmoscopically.
Retina: An increase in IOP decreases the axoplasmic flow in the retina and the blood supply to the eyeball in general, causing ischemia. As soon as the pulse pressure (systolic pressure - intraocular pressure) drops, ischemia occurs. This ischemia can be demonstrated functionally in the form of suppression of the electroretinogram. Even a slight increase in IOP
reduces axoplasmic current and induces axonal collapse. Even after a short period of ischemia, recovery of retinal ganglion cells is unlikely. Nerve fibers and a layer of retinal ganglion cells begin to degenerate at an early stage of glaucoma and may not even be detected on histological sections. In chronic progressive glaucoma, the outer layers of the retina also disappear, and ultimately the entire retina is replaced by a glial scar. Ophthalmoscopically, this is manifested by an increase in the tapetum reflex, as with other severe retinal atrophies. This condition is irreversible.
Choroid: With an acute increase in IOP (between 40 and 50 mm Hg in dogs), the constrictor of the pupillary muscle is paralyzed, which causes dilatation of the pupil. With constant, long-term high pressure, the muscles and stroma of the iris, the ciliary body and its processes atrophy, due to a decrease in blood supply as a result of high IOP. Atrophy of the ciliary body and the associated decrease in the production of intraocular fluid deserves special attention, since it explains the balance between increased IOP and scleral distension and the occurrence of buphthalmos in progressive chronic glaucoma in dogs. In such eyes, the production of intraocular fluid decreases, the eye no longer stretches and the condition becomes bearable for the animal, despite progressive pathological changes and an ugly appearance. Atrophy of the iris is clinically visible, since the iris takes on the appearance of a rare lace, through the holes in which the tapetum reflex (retroillumination) is clearly visible. In animals, unlike humans, iris atrophy is not the cause of glaucoma, but only its consequence.
Lens: Cataracts often occur in chronic glaucoma, often in association with lens suction or subluxation. The simultaneous combination of glaucoma and lens luxe requires clarification of whether lens luxe is the cause or result of glaucoma. Since, with an increase in intraocular pressure, the sclera stretches, the ciliary fibers break and the lens shifts. Likewise, primary cataract formation often leads to lens luxation and glaucoma. Thus, the combination of glaucoma, cataract, and lens luxation in any particular eye can occur in a variety of ways. Any of these three pathologies can be primary. Primary lens luxation, which is common in terriers and border collies, can cause pupillary block with an acute increase in IOP. Secondary lens luxation resulting from glaucoma can also cause pupillary block and aggravate the course of glaucoma. Lenticular-induced uveitis, due to a secondarily luxurious lens, which becomes cataractous due to an increase in IOP, can cause a decrease in IOP (due to the development of uveitis and, accordingly, a decrease in the production of intraocular fluid), which further complicates the diagnosis and treatment.
Cornea: In acute glaucoma, impaired function of the corneal endothelium due to high IOP and imbalance between hydration and dehydration processes in the corneal stroma, causes corneal edema. Epithelial edema may also occur, with the formation of epithelial blisters. In chronic corneal edema, which is a consequence of glaucoma, both superficial and deep vascularization and pigmentation often occur. The presence of this vascularization makes the differential diagnosis of glaucoma and uveitis even more fundamental, especially if the eye is preserved.
Sclera: In chronic glaucoma, the sclera stretches and the eyeball enlarges (buphthalmos). Scleral stretching is irreversible, even if IOP later returns to normal. The enlargement of the eyeball is much faster in young dogs than in adults, however, not all eyes with glaucoma undergo stretching. By the time buphthalmos has developed, vision is lost, although the intensity of pain may vary.
Treatment methods for absolute (terminal) glaucoma
Absolute glaucoma can be extremely painful and debilitating for an animal. Patient comfort should be paramount when treating disease at this stage.
There are several treatments:
The use of filter / drainage devices for the treatment of glaucoma in dogs and cats has shown an unacceptable, unacceptably high complication rate when followed over several decades (Magrane, 1965; Gelatt et al, 1987). The failure rate was 66.6% within 3 months with treatment, and 71.4% within 2 years with prevention of glaucoma (Bentley et al, 1996).
Cyclocryotherapy or laser cycloablation
The essence of these methods lies in the destruction of the ciliary body using exposure to cold (cyclokryotherapy) or laser energy (laser cycloablation). Liquid nitrogen oxide is usually used as a cold carrier; and as a source of laser energy - neodymium: yttrium-aluminum-ruby (Nd: YAG) laser. These techniques lead to improvement only in the presence of a sufficient amount of the ciliary body to damage, since, only in this case, the production of intraocular fluid can be reduced. Observations indicate that there is a likelihood of achieving the same success with the use of carbonic anhydrase inhibitors. In the presence of buphthalmos, the eyeball does not shrink after cycloablation, and the use of an intraocular prosthesis is cosmetically more acceptable.
Evisceration
The method consists in removing the inner contents of the eyeball through a limbal incision. The remaining connective tissue frame of the eye is filled with blood, which, after the clotting process is completed, grows with connective tissue, forming a natural intraocular endoprosthesis. The method of evisceration is technically simple, the percentage of postoperative complications is quite low, but, due to a strong decrease, subsequently, of the eyeball, the cosmetic effect of the operation is insufficient, and the twist of the eyelids arising from the discrepancy between the sizes of the orbit and the eyeball, in combination with abundant discharge from the conjunctival cavities, can be a source of discomfort for the animal and cause the need for additional care for the owner.
Intraocular prosthetics
The eyeball is eviscerated by removing the internal components of the eye through a limbal incision, leaving only the connective tissue frame of the eye - the cornea and sclera. After stopping the bleeding, a silicone prosthesis is implanted. Since most owners strongly prefer to keep the eye as an organ, this method is extremely convenient and practical. Postoperative complications are minimal and long-term postoperative therapy is not required.
The enlarged eyeball is reduced to the size of the prosthesis 3-4 weeks after surgery. During this period, the cornea can become intensely vascularized and turn red. This process gradually declines and, ultimately, the cornea becomes gray or black. The degree of pigmentation cannot be predicted in advance and owners should be advised of this prior to surgery. Prosthetics can also be used after severe injuries to prevent atrophy and shrinkage of the eyeball and to maintain a cosmetically acceptable eye. When performing intraocular prosthetics by a qualified surgeon, a very high success rate is achieved. The complication rate is less than 1% (Koch SA, 1998). The most common complication after surgery is the development of ulcerative keratitis, which, in most cases, is treatable. The contents of the eyeball removed during prosthetics should be examined histologically to exclude neoplasia.
Enucleation (removal of the eyeball)
If the eye has been fully and thoroughly examined and diagnosed with absolute glaucoma with severe pain, the owner may decide to remove the eyeball. This is rarely necessary, except in cases of suspected neoplasia or uncontrolled infection, since the intraocular prosthetics technique is extremely successful and does not entail any problems or complications. The same degree of pain relief and restoration of normal animal behavior is achieved with intraocular prosthetics as with enucleation in the case of chronic glaucoma, therefore intraocular prosthetics can be considered as a progressive modification of the evisceration and enucleation process. To protect the patient and the veterinarian and in the interests of general medical practice All enucleated eyeballs should be examined by an experienced veterinary ophthalmic pathologist.
For most glaucoma patients, enucleation is not a substitute for specific diagnosis and treatment; it is an indicator that the diagnosis, therapy, as well as the patience and desire of the client have failed, and, often, this procedure is chosen for economic reasons.
surgeries in terminal aching glaucoma
A.D. Chuprov, I.A. Gavrilova
Kirov Ophthalmologic Hospital, Kirov
Purpose: to compare results of various types of preserving surgery in terminal aching glaucoma.
Methods: analysis included indices of visual acuity, tonometry (by Maklakov), measured before operation, in early postoperative period (5-7 days) and in 1-2 year after surgical antiglaucomatous treatment.
Results: Data of 72 patients with terminal aching glaucoma which underwent surgical treatment in period of 2005-2010 was analyzed. Visual acuity varied from complete blindness to light sensitivity with incorrect projection. Average level of ophthalmotonus on the background of medicamental treatment was 41.6 ± 0.91 mm Hg, and there was also pain syndrome in all patients. All patients were divided into 3 groups depending on the type of the surgery. First group included patients after filtering surgery (22 eyes), second (20 eyes) - after sclerectomy with cyclocryopexy, and third (30 eyes) - after diode laser transcyclocoagulation.
Stable normalization of IOP level was reached in 18 patients of the 1st group (81.8%), in 18 patients of the second group (90%) and in 26 patients of the 3rd group (86.7%). Pain syndrome was eliminated in all patients.
Conclusion: preserving surgery may be considered as efficient treatment of patients with terminal aching glaucoma.
Relevance
Glaucoma is one of the most common and severe eye diseases: the number of people who are blind due to glaucoma, according to various authors, varies from 5.2 to 9.1 million people. In Russia, glaucoma takes the 1st place in the nosological structure of visual disability, its share increased from 14% in 1997 to 28% in 2005. In addition, during the re-examination of disabled persons with group III a year after the initial disability was established, the relative stabilization of the disease ascertained only in 54.8% of cases; in 29% of disabled people due to progression, group II was established, and in 16.2% - group I [Libman ES, 2000-2005]. Thus, the number of patients with end-stage glaucoma does not decrease over the years.
The goal of treating such patients is usually to relieve pain. Drug therapy for terminal glaucoma is often ineffective due to pronounced dystrophic changes in the drainage system of the eye and ciliary body, iris rubeosis. At the same time, surgical treatment is accompanied by a significant number of intra- and postoperative complications; therefore, the choice of a treatment method is often ambiguous. Currently, various types of organ-preserving operations are used, both fistulizing and cyclodestructive.
Objective of the study: to compare the results of various organ-preserving operations in terminal painful glaucoma.
Materials and methods
We analyzed the results of surgical treatment of 72 patients with terminal painful glaucoma at the Kirov Clinical Ophthalmological Hospital for 2005-2010. The age of the patients is 48-79 years old; men accounted for 47.2% (34 people), women - 52.8% (38 people). Primary glaucoma was diagnosed in 40 patients, various forms of secondary glaucoma - in 32 patients. Visual acuity equal to zero was in 47 people, light perception with incorrect light projection - in 25 people. The average level of ophthalmotonus according to Maklakov against the background of maximum drug therapy was 41.6 ± 0.91 mm Hg, pain syndrome of varying severity was observed in all patients.
Patients of the 1st group (22 eyes) underwent various fistulizing operations (deep sclerectomy with preliminary posterior trepanation of the sclera, deep sclerectomy with drainage, two-chamber drainage), patients of the 2nd group (20 eyes) - multiple sclerectomy with direct cyclocryopexy, patients 3 group (30 eyes) - diode laser transscleral cyclophotocoagulation (TCFK). The period of observation of patients after surgery is from 1 to 2 years.
Results and discussion
Stable normalization of ophthalmotonus was achieved in 18 patients of the 1st group (81.8%), 18 patients of the 2nd group (90%) and 26 patients of the 3rd group (86.7%). Pain syndrome was eliminated in all patients, which is of great importance for patients with terminal painful glaucoma. The hypotensive effect of surgical interventions in the early postoperative period (5-7 days after the operation) and the long-term period (after 1-2 years) is presented in Table 1.
As follows from the presented data, in the early postoperative period, the decrease in IOP is more pronounced in patients of the 1st group (fistulizing operations). But in the long-term period, the pressure in this group again increases, while after cyclodestructive interventions there is a gradual persistent decrease in ophthalmotonus.
The following intra- and postoperative complications were recorded (Table 2).
Attention is drawn to the fact that the prevailing complications in the 1st group and 2-3rd groups are different. Ciliochoroidal detachment - the most frequent complication of fistulizing operations, often requiring posterior sclerotomy - is practically not encountered with cyclodestructive interventions. A formidable intraoperative complication - expulsive bleeding - was observed during 1 operation in group 1. At the same time, in more than half of patients in groups 2-3, the postoperative period was complicated by iridocyclitis of varying severity (often with fibrinous effusion into the anterior chamber), in many it was accompanied by pain syndrome for 1-2 weeks. The incidence of hemorrhagic complications, corneal dystrophy, as well as postoperative hypotension and subatrophy is comparable in all groups. Thus, the number of complications in the 1st group is higher than in the 2nd and 3rd groups.
We noticed that the hypotensive effect in groups 2 and 3 did not differ significantly. Also, in these groups, there is practically the same number of complications, with the exception of prolapse of the vitreous body, which was recorded only with perforating interventions.
When choosing the method of surgical intervention in patients with terminal painful glaucoma, several points should be taken into account. First, as it was shown above, the number of complications with non-perforating interventions is less than with perforating ones. Secondly, TCFK is a technically simple procedure and is available even to novice surgeons. Thirdly, elderly and old patients often have a "bouquet" of concomitant diseases, therefore, the duration of the operation and anesthetic benefits are important, which again is an argument in favor of transscleral laser cyclophotocoagulation.
conclusions
1. Organ-preserving operations are an effective method of treating patients with terminal painful glaucoma.
2. Transscleral laser operations are shorter, technically simpler and safer than perforating interventions, which makes it possible to recommend them as the surgery of choice for terminal painful glaucoma.
Literature
1. Bachaldin I.L., Egorov V.V., Marchenko A.N., Sorokin E.L. Transscleral diode laser cyclocoagulation in the treatment of terminal painful glaucoma // BC. 2007. T. 8.No.4.
2. Bessmertny A. M., Robustova O. V. Combined treatment of neovascular glaucoma in patients with object vision // Glaucoma. 2004. No. 2. S. 34-37.
3. Dumnov E.V., Lebedev O.I. The use of a combined method of laser treatment in secondary neovascular glaucoma // Glaucoma. 2009. No. 1. S. 40-42.
4. Zhaboedov GD, Kovalenko Yu.V. Comparative evaluation of the effectiveness of methods of diode laser trans-scleral cyclocoagulation in the complex treatment of patients with primary open-angle glaucoma // Oftalmol. magazine. 2006. No. 3. S. 156-157.
5. Klyuev G.O. Laser trans-scleral contact-compression cyclocoagulation with age-related changes in eye structures // Glaucoma: theories, trends, technologies. HRT Club Russia - 2008: VI International Conference: Materials. M., 2008.S. 273-281.
6. Mazunin I.Yu., Kraeva A.A., Kravetskaya E.I. Dynamic microimpulse diode laser transscleral cyclocoagulation (DMIDTCK) in the treatment of advanced stages of glaucoma // Glaucoma: theories, trends, technologies. HRT Club Russia - 2009: VII International Conference: Materials. M., 2008.S. 357-360.
7. Mikheeva E.G., Popova O.E., Yablonskaya L.Ya. Clinical efficiency of organ-preserving operations in terminal glaucoma // Glaucoma: theories, trends, technologies. HRT Club Russia - 2008: VI International Conference: Materials. M., 2008.S. 462-465.
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The main symptom of the disease is an increase in intraocular pressure. The pathological process goes through several stages, of which the final stage is terminal glaucoma. At this stage, irreversible blindness may occur, sometimes it is possible to preserve light perception.
Development of terminal glaucoma
In the absence of appropriate treatment for the disease, glaucoma passes into the final stage, which is called terminal. Changes to gradually progress: atrophy of the optic nerve develops, dystrophic processes occur. This is accompanied by a decrease in visual acuity and impairment.
If the disease is accompanied by severe pain in the eye, then they speak of "terminal painful glaucoma." It is accompanied by a sharp, exhausting pain that radiates to the half of the face and head corresponding to the lesion. It is as strong as in trigeminal neuralgia or inflammation of the pulp of a carious tooth. Such pain does not respond to medication. You can get rid of it only with the help of surgery, which treatment allows you to normalize intraocular pressure.
There are other signs of this disease:
- eyeball;
- nausea and vomiting.
The symptoms described above are due to edema, as well as irritation of its nerve endings. With such pathological changes, the corneal tissue of the eye becomes susceptible to various infectious diseases. The following complications of this disease are quite common:
- (corneal inflammation);
- (tissue inflammation);
- perforation of the cornea.
Terminal glaucoma prevention methods
Glaucoma is dangerous because it manifests itself in a minimal number of symptoms. While the patient is not worried about anything, he is in no hurry to see a doctor. Time passes, and the pathological changes that take place in the fundus increase, while visual acuity decreases. Doctors recommend that even practically healthy people undergo preventive examinations by an ophthalmologist at least once a year.
After a diagnosis of glaucoma is established, patients need to see an ophthalmologist at least three times a year. With regular medical examinations, complex treatment and timely correction of the therapy, the progression of the disease and blindness can be avoided.
Terminal glaucoma treatment methods
The prognosis for recovery and preservation of vision in end-stage glaucoma is poor. Those pathological changes that occur in the fundus are irreversible, which means that it is almost impossible to restore vision. Treatment of the terminal stage of glaucoma consists in relieving pain and, if possible, preserving the cosmetic function of the eyeball.
Today, minimally invasive surgical interventions are being developed, the purpose of which is to normalize intraocular pressure by improving drainage function and preserving the eye. In each case, an individual plan for the treatment of glaucoma is developed. If it is not possible to carry out an organ-preserving operation, then the eyeball is removed.
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