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Glaucoma

Our task is to save your vision!

Currently, over 75 million people worldwide suffer from glaucoma, but only half of them know about their condition and an even smaller number of patients receive adequate treatment. Glaucoma is the main cause of permanent blindness!

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You should remember! Loss of vision in glaucoma is irreversible. Without timely treatment vision can be completely and irrevocably lost!

In our eye clinic, for prompt diagnosis and treatment of glaucoma, we use the full range of new instrumental methods for determining the forms and stages of glaucoma and perform conservative therapeutic, surgical and laser treatment of this threatening disease.

What is glaucoma?

Glaucoma is a chronic, progressive eye disease caused by constant or periodic increase of intraocular pressure which kills nerve fibers of the retina and the optic nerve, resulting in typical defects in the visual field; visual functions deteriorate up to a complete loss of vision.

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Glaucoma is the main cause of permanent blindness!

You should know! Glaucoma is an insidious disease, which at the initial stages has no symptoms and is not felt by the patient. Therefore, the only way to detect this disease is preventive examination! by an ophthalmologist

The causes and mechanisms of glaucoma development

The pressure in the hydrodynamic system of the eye is constant and equal to 18-22 mm Hg, which is achieved due to the balanced mechanism of production and outflow of intraocular fluid. When the balance between production of intraocular fluid and its outflow is disrupted, intraocular pressure (IOP) increases. With an increase in intraocular pressure, the optic nerve and other structures of the eye due to excessive pressure on the eye tissues experience ischemia, which is accompanied by hypoxia, particularly in the area of the optic nerve output. As a result nerve fibers are damaged, the optic nerve atrophies and visual signals stop entering the brain. Vision deteriorates, including peripheral one, visibility zone narrows, and this is followed by complete blindness.

What are the main symptoms of glaucoma?

Despite the fact that the initial stages of glaucoma are asymptomatic, patients may note its various manifestations. The following symptoms are the most frequent

  • occasional “blurred” vision;
  • iridescent circles around light sources;
  • possible pressing pain, feeling of heaviness in the eyes;
  • blurred vision in the evening and at night;
  • narrowed visual field;
  • redness of the eyes.

If you notice these symptoms, immediately consult an ophthalmologist and undergo specialized diagnostic examination!

You should remember! Early diagnosis and appropriate treatment of glaucoma are the main factors that prevent loss of vision and blindness. Preventive examination is required for all people over 40 years of age, and should be conducted at least once a year. For those whose relatives suffer from glaucoma, preventive examination should start at an earlier age.

MAIN TYPES OF GLAUCOMA

Glaucoma is a common and dangerous disease. Mostly it affects people over the age of 40, but there is also youth glaucoma and even infantile glaucoma.

Glaucoma can be congenital or acquired. In case of congenital glaucoma, newborns manifest elevated intraocular pressure, and in some cases an increase in the size of the eyeball. This form of glaucoma develops because of genetic defects of the structure of the eye drainage apparatus. Acquired glaucoma is much more common.

The main types of glaucoma are:

  • congenital;
  • acquired;
  • youth (occurs in adolescence);
  • open-angle;;
  • closed-angle (occurs with pain attacks);
  • secondary (result of other eye diseases).

What stages of glaucoma are there?

There are 4 stages of glaucoma development. hey manifest by a change in the visual field and by excavation (lat. excavatio – “deepening”) of the optic disc..

These are::

  • initial stage;
  • developed stage (visual field narrowing, blurred vision);
  • advanced stage;;
  • terminal stage (sharp deterioration of vision up to blindness).

what examination is carried out for glaucoma?

In our clinic we carry out a complete diagnostic examination to assess the state of all the structures and systems of the eye. In addition to classical methods of diagnosis: visual acuity measurement, biomicroscopy, gonioscopy, intraocular pressure measurement, visual examination of the fundus condition (ophthalmoscopy), we use modern methods. Among them there is computerized diagnostic study of the visual field (computer perimetry), optical coherent tomography of the optic disc and the assessment of nerve fibers. These studies are the most informative ones for glaucoma and they help to accurately diagnose and determine the stage of the disease, which is very important for the elaboration of further treatment tactics..

how is glaucoma treated today?

All treatments for glaucoma are aimed at normalizing intraocular pressure, improving trophism in the eye tissues and the optic nerve as well as stabilization of visual functions..

You should remember! Timely treatment of glaucoma is the key to preservation of visual functions and prevention of blindness!

Conservative treatment of glaucoma

Conservative treatment of glaucoma consists of administering drugs in the form of eye drops. This therapy is the most common in the early stages of glaucoma treatment. Some drugs are aimed at reducing the production of intraocular fluid. Other drugs, using special mechanisms, are aimed at improving the outflow of intraocular fluid, thereby reducing intraocular pressure. There are also combination drugs that combine both functions.

You should remember! Drug treatment of glaucoma is prescribed by an ophthalmologist only after a complete eye examination. A choice of the optimal therapeutic regimen (antihypertensive therapy) is made on an individual basis, taking into account the data obtained during ophthalmic examination.

There are a large number of anti-glaucoma medications, which are prescribed for patients suffering from glaucoma. Among them there are drugs such as Azopt, Arutimol, Alphagan, Betaxololum, Betoptic, Betoftan, Brinzolamidum, Glaucon, Glauprost, Dipivefrinum, Dorzolamidum, Dorzopt, Duotrav, Isopto-carpine, Carbachol, Cosopt, Xalatan, Xalacom, Clonidinum, Cusimolol, Latanoprostum, Nyolol, Normoglaucon, Ocumed, Ocumol, Oftan Pilocarpin, Proxophelin, Pilocarpine hydrochloridе, Travoprostum, Travatan, Timololum, Timohexal, Timoptic, Trusopt, Fotil, Epinephrinum. All these drugs are prescribed individually. Their action is analyzed together with control of intraocular pressure, and subsequently the optimum regimen and schedule of instillation are chosen.

You should remember! Self-treatment of glaucoma is very dangerous! Do not use and do not cancel anti-glaucoma drugs on your own! Do not alter the mode and frequency of instillation! These actions can cause irreparable damage to your eyes, so you risk losing sight!

Laser treatment of glaucoma

Laser treatment of glaucomais used when the effectiveness of conservative drug therapy is reduced. It is meant to generate additional outflow tracts for intraocular fluid. Trabeculectomy, trabeculoplasty and trabeculopuncture are the types of laser surgeries for treating open-angle glaucoma. For treating closed-angle glaucoma laser iridectomy is performed. The advantages of laser treatment of glaucoma include:

  • restoring drainage without surgery;
  • low invasiveness;
  • outpatient basis;
  • no postoperative complications;
  • minimum period of rehabilitation.

Surgical treatment of glaucoma

Surgical treatment of glaucoma is aimed at creating an alternative system of intraocular fluid outflow or at normalizing the circulation of intraocular fluid (or reducing its production). As a result, intraocular pressure is compensated without medications. Typically, surgery is indicated in case of reduced or zero effectiveness of drug treatment and loss of the effect of laser surgery. Glaucoma operations are divided into the following types::

  • Non-penetrating (nonfistulizing) glaucoma surgery. For example, non-penetrating deep sclerectomy.
  • Penetrating (fistulizing) glaucoma surgery. For example, trabeculectomy.
  • Surgeries normalizing circulation of aqueous humor. For example, iridocycloretraction.
  • Surgeries reducing production of aqueous humor. For example, cyclocryocoagulation.

Of special note are modern trends in glaucoma surgery, which are based on the use of drains. We recommend using drains in cases where the patient has previously been operated for glaucoma. For example, after trabeculectomy and/or non-penetrating deep sclerectomy, or after refractory glaucoma surgery. Drainage systems provide a longer hypotensive effect compared to other surgical procedures. Among the best known drainage devices we should mention Ahmed™ valve system in different versions used in glaucoma surgery since 1993.

Клапанная система Ahmed™

Microdrainage systems are also successfully used in glaucoma surgery. The drainage system ExPRESS (Alcon), which provides a high antihypertensive efficacy, is widely used in modern glaucoma surgery. Mini-shunt ExPRESS is a hollow tube 3 mm long, with an outer diameter of 400 nm (27 G) and inside diameter of 50 nm.

Мини-шунт ExPRESS (Alcon)

Another area of ​​drainage surgery is the implantation of drains into filtering bleb to prevent excessive conjunctival and scleral scarring in the postoperative period. Such drains are made of different materials such as silicone, collagen derivatives, amnion, alloplant and others.

The period of rehabilitation after surgery for glaucoma is usually minimal. There are small restrictions in the postoperative period, but the patient can get to work within a few days.

You should understand! The question of the surgical treatment of glaucoma is answered individually, on the basis of glaucoma dynamics. The decision depends on the form and stage of the disease, the level of intraocular pressure increase, the outflow rate, the state of the anterior chamber angle, the visual field, as well as the general physical condition of the patient.

When is it time to operate glaucoma?

In case of decompensation of intraocular pressure given drug antihypertensive therapy and progressive deterioration of visual functions, surgical treatment is performed, i.e. surgeries to create an alternative system of intraocular fluid outflow.

Prevention of glaucoma

Preventive visits to an ophthalmologist, early detection of glaucoma and its timely treatment are the main methods that can prevent blindness stemming from this disease. In this regard, preventive examinations by an ophthalmologist are necessary for people over 40 years of age, not less than once a year. But for those whose relatives suffer from glaucoma such examinations should start at an earlier age..

You should remember! Glaucoma is a chronic disease that requires lifelong supervision and treatment by an ophthalmologist. Thanks to modern antihypertensive drugs, laser and other types of surgeries vision can be maintained at a high level for a long time. If you do not follow the recommendations of your ophthalmologist, vision will continue to deteriorate, leading eventually to blindness!

What is “acute glaucoma”?

This is a very dangerous condition that occurs as a result of a sharp increase in intraocular pressure. It is accompanied by severe pain and can lead to loss of vision, and in the absence of timely treatment to permanent blindness.

Acute glaucoma begins suddenly, usually with pain in the eyeball and the respective half of the head, most often – in the occipital region; it can be accompanied by nausea, vomiting and general weakness. Acute glaucoma can often be confused with migraine, hypertensive crisis and even poisoning. Sometimes there is pain felt in the heart and abdomen, similar to the symptoms of a cardiovascular event.Wrong diagnosis leads to serious consequences because of the wrong treatment and lack of emergency care.

Acute glaucoma begins for no apparent reason. The patient suddenly experiences the following symptoms:

  • redness of the eye;;
  • pain in the eye and in the head;
  • blurred vision;;
  • appearance of iridescent circles when looking at light sources;
  • deteriorated vision..

Acute glaucoma is a critical condition: intraocular pressure may increase up to 60-80 mm Hg; outflow of intraocular fluid from the eye stops almost completely. To the touch the eye is like a stone. Acute glaucoma is an emergency and requires qualified emergency eye care!

You should know! If within 48 hours after the onset of acute glaucoma intraocular pressure is not lowered with medications or laser/surgical treatment, the optic nerve dies and loss of vision becomes irreversible!

To make an appointment at Dr. Kurenkov’s Clinic or to get information on the cost of examination and treatment, please call: +7 (495) 781-93-33.

The price of glaucoma surgery starts from 5,000 rubles.

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