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Bakhritdinova Fazilat Arifovna, Tashkent Medical Academy, Department of eye diseases, Doctor of medicine, professor E-mail: [email protected] Mirrakhimova Saidakhon Shukhratovna, Department of eye diseases, PhD, docent E-mail: [email protected] Karimov Ulugbek Rasulovich, Sirdarya Regional Ophthalmic Hospital, Departamant of microsurgery, Ms.D. E-mail: [email protected] Narzikulova Kumri Islamovna, Department of eye diseases, PhD, senior teacher E-mail: [email protected]
The results of medicated decreasing of intraocular pressure at neovascular glaucoma
Abstract: The usage of combined fixed, hypotensive drug brimoptic in NVG leads to an authentic decrease IOP, especially in NVG second stage (p < 0.05). In third stage of NVG, given drug is recommended for decrease of IOP in preoperative
period of fistulaized operation.
The results of medicated decreasing of intraocular pressure at neovascular glaucoma
Keywords: intraocular pressure, neovascular glaucoma, brimoptic, fixed combine preparation.
Relevance
Neovascular glaucoma (NVG) is one of the severe and prognostic unfavorable form of secondary glaucoma that develops due to diabetes, atherosclerosis of carotid artery and chronic uveitis [1, 6-9; 2, 9-11; 3, 19-23]. In fact the pathogenic factor of given process is severe chronic ischemia of inner parts of the retina. Appeared hypoxic zones of the retina produce vasoproliferative agent during the process of revascularization, then it spreads to the anterior segment of the eye. As a result iris rubeosis and fibrovascular membrane occur at the angle of anterior chamber. Hurdles of outflow caused in open angle of anterior chamber can further lead to the secondary angle closure glaucoma that treatment is problematic. There are three stages of NVG according to M. B. Schields (1997) classification: first — iris rubeosis, initial rubeosis of angle of anterior chamber, IOP is normal; second — secondary glaucoma with open angle of anterior chamber and third stage — glaucoma with closed angle of anterior chamber.
The main method of treatment of NVG is surgical intervention that based on principles ofpathogenesis (self-draining, fistulized and other) and in half cases connected with risk of operative and postoperative complications of hemorrhagic genesis. Because of cicatricial complications, the block of created zones offiltration is occurred by cicatricial tissue and IOP can be elevated [4, 129; 5, 346-351; 6, 26; 7, 24; 8, 161; 9, 143].
These days for prophylaxis of postoperative and intraoperative complications, some schemes of prepared treatment are acknowledged as effective: hypotensive preparation, anti-VEGF therapy, corticosteroid therapy, laser methods, cyclodestructions, cyclopotocoagulations, photodynamic therapy [10, 1695-1705; 11, 247-249; 12, 1695-1705]. For compensation of IOP in preoperative period, at present days in the pharmacologic market of Uzbekistan there are a plenty of preparations of ^-blockers, ICA and a-agonists [13, 259-260; 14, 253-254]. However, previously their hypotensive effectiveness was studied only in POAG or examinations were carried out in different ethnic groups [15, 14-17].
The treatment of POAG was carried out with a new combined fixed preparation Brimoptic (Liquar, Armenia) in our ophthalmologic clinics of the Tashkent Medical Academy. Preparation contains two main ingredients: orimodin tartrat, that is considered to be a presenter of second generation of selective a 2 agonists, which selectivity is 30 times more than other presenters of given group, and timolol maleat — non-cardioselective p — adrenobloker. The mechanism of influence of brimonidin connects with restriction of production of fluid of anterior chamber and along with it accelerates uveoscleral outflow of intraocular fluid. The analysis of carried out clinic examinations illustrated the high initial hypotensive and vasoconstrictive effects of preparation in POAG. During the acute drug test that depends on initial level, IOP decreases by 6 -21 mm. Hg. in 91 % cases, does not influence on the size of pupil during the prolonged drops. Considering observed specialty of brimoptic, we thought appropriate to assess hypotensive activity of brimoptic in NVG, in its different manifestations, accompanied with elevated IOP.
Table 1. - Dynamics of
Aim of research — to study effectiveness of combined fixed hypotensive preparation in NVG.
Materials and methods
Under our observation was 42 patients (42 eyes) with NVG, from them developed as a complication of thrombosis central vein of retinae — 15 patients (30 eyes), diabetic retinopathy — 20 patients (20 eyes) and chronic uveitis 7 patients (7 eyes). From them — 22 men and 20 women, age ofwhom made up 48-78 years. Patients were distributed into two groups depending on usage of hypotensive drops based on adequate etiological treatment: The main — patients dropped in brimoptic 1-2 drops 2 times per day and control group — with the same scheme hypotensive combined fixed preparation azarga (timolol + brinzolamid) was instilled. All groups were homogeneous in terms of stage of NVG with level of IOP (according to A. P. Nesterov classification, 1990). Patients with NVG — second stage (secondary open angle glaucoma) — 30 eyes and NVG third stage (secondary angle-closure glaucoma) — 12patients (12 eyes). All patients were underwent standard ophthalmologic examinations. Visual acuity from 0.05 to 0.2 with correction. The date of investigation made up 3 months.
Results and discussions
After dropping hypotensive preparation, there was a steady decrease in the level of IOP in both groups after 30 minutes and reached figure for (20.6 ± 2.69) after 2 hours. On the fifth day of treatment the level of IOP was stabilized almost in all patients with NVG of the second stage, except 1 case in control group, where the level of IOP increased to 26-27 mm. Hg. that was connected with progression of inflammation of uveal tract and prolonged scarring of angle of anterior chamber. In both groups of patients with NVG III stage the level of IOP was noncompensated and then after adequate preparation the fistulized operations were successfully performed.
In date to 3 months at 29 patients (29 eyes) with NVG the level of IOP stayed constantly within in normal (p < 0.001). A considerable improvement of visual functions was noticed from 0.14 -0.35 in the main group in comparison to visual functions in control group (p < 0.05) (table 1).
Peripheral borders of visual fields enlarged by 15 -20°, 56 % cases in control and by 12-18° at 50 % patients of control group (p < 0.05). Systematic usage of brimoptic in all date of observations decreased slightly arterial pressure of patients, (due to general hypotensive effect), that was optimal for general condition of patients with elevated AP. It is noted that hypotonic patient should be prescribed brimoptic with caution under control of AP.
Thus, the results of clinic examinations allowed to determine that drug therapy with combined fixed preparation brimoptic and azarga proved to be effective in NVG II stage. Prescription of brimoptic due to additional constrictional effect of brimonidin leads to normalization of IOP with first hours, by providing safety visual functions considerable more than compared drug. In case of NVG III stage brimoptic as a drug with high initial hypotensive position should be used at the stage of preparation to fistulized an-tiglaucomatous operations.
IOP during the treatment
Name of drug Initial IOP After 30 minutes After 1 hour After 2 hours After 6 hours After 12 hours After 4 weeks After 12 weeks
Brimoptic 29.13 ± 3.15 26.90 ± 3.72 23.2 ± 2.78 20.61 ± 2.71* 23.25 ± 2.55* 20.62 ± 2.59** 20.32 ± 2.11** 20.61 ± 2.71*
Azarga 29.18 ± 3.17 27.1 ± 4.14 23.0 ± 2.78 21.32 ± 2.28* 24.14 ± 2.53* 21.31 ± 2.69** 21.50 ± 2.28** 21.32 ± 2.28*
Note: * — P < 0.05; ** — P < 0.001.
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Berkinov Ulugbek Bozorbaevich, Professor in the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan Sakhiboev Dilshod Parpijalilovich, Assistant in the department of faculty and hospital surgery
E-mail: [email protected] Irnazarov Akmal Abdullaevich, Docent in the department of faculty and hospital surgery
Results simultaneous operations in patients with adrenal tumors
Abstract: In the period from 2013 to 2015 the 2-clinic of Tashkent Medical Academy for examination and treatment were 46 patients with adrenal tumors. Simultaneous operations were performed in 6 patients, of whom 4 women and 2 men. A morphological study of adrenal tumors, we found: 2 — aldosteroma (33.3 %), 1 — pheochromocytoma (16.6 %), 1 — adrenal cyst (16.6 %), 2 — cortex adenoma (33.3 %). Of these, 50 % patients were with intsidentaloma (2 cortical adenoma and 1 adrenal cyst). Indications for simultaneous operations were a combination of adrenal tumors with cholelithiasis and umbilical hernia. At the same time in 4 (66.6 %) patients simultaneously conducted operations — right-sided laparoscopic adrenalectomy, and laparoscopic cholecystectomy, in 1 patient (16.6 %) — a left laparoscopic adrenalectomy and laparoscopic cholecystectomy and 1 (16.6 %) patient's after adrenalectomy surgery hernia repair is made to the type of allopath «on lay».
In postoperative period complications were not observed. On the next day after surgery drains removed and all patients are activated. Average bed day was 4 ± 1.71. Thus, the analysis of these patients treatment results showed that the duration of surgery and hospital stay do not differ from similar parameters specific to patients with isolated surgical pathology. Treatment simultaneously several surgical diseases liquidate of need for repeated operations and its risk of possible complications. All of the above underscores the feasibility and cost-effectiveness of performing simultaneous operations in patients with concomitant surgical pathology.
Keywords: tumor of adrenal glands, simultaneous operations, laparoscopic adrenalectomy.
