Ophthalmologists share frightening case studies
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“Nightmares of glaucoma” – a conference with this name was held for the second time by the Russian Glaucoma Society (RGO). On the eve of Halloween, doctors from all over the country spoke about the most interesting and sometimes frightening cases from their practice, shared their experience of the course of an insidious disease that can take on the most terrible forms, and discussed proposals on how to deal with this enemy that steals people’s eyesight.
Glaucoma is a chronic progressive eye disease. Glaucoma is caused by the death of nerve cells in the inner surface of the eye membrane that form the optic nerve. Most often (and for a very long time!) the disease proceeds without obvious manifestations, does not cause complaints and is usually detected by chance during examination by an ophthalmologist. Often, glaucoma is not diagnosed and, therefore, not treated until the advanced stages of the disease occur, characterized by rapid loss of vision and, in some cases, complete blindness.
Today in Russia, about 1,400,000 people suffer from glaucoma, and another half of this number, most likely, are also already sick, but do not know about it. In our country, the disease is detected in patients older than 60 years, but glaucoma, of course, can also occur in younger people.
“Each glaucologist in his practice is faced with situations that are beyond his power, no matter how experienced he may be. Therefore, we came up with a project that will help doctors share interesting (and difficult!) Cases from practice with us and understand how to act in such unpleasant situations so that they can solve them on the spot, ”says a well-known ophthalmologist, head of the ophthalmological center of the Central Military Clinical hospital them. P.V. Mandryka of the Ministry of Defense of the Russian Federation, Professor of the Department of Ophthalmology. ak. Nesterova A.P. RNIMU them. Pirogov Ministry of Health of the Russian Federation Alexander Kuroyedov.
The scientific secretary of the Russian Geographical Society, Doctor of Medical Sciences, spoke about the nightmares and horrors of medical examination of glaucoma patients. Ilmira Gazizova (St. Petersburg). Sometimes mistakes in medical examinations lead to tragic consequences, as happened with her patient. His profession required annual dispensary examinations, including an ophthalmologist. And until the age of 40, he did this – his eyesight did not give cause for concern. But then the situation changed, it became long and expensive to get a certificate – and the patient began to issue it in roundabout ways. Until the age of 60, he lived and worked with virtually no visits to an ophthalmologist. And then one day the wife drew attention to his reddened eye, he went to the doctor, and during the reception it turned out that he did not see the eye at all. Today, Dr. Gazizova is fighting for vision in the only seeing eye, which is not yet completely lost, but glaucoma is already in an advanced stage there. “This situation could have been avoided if the patient had not stopped dispensary observation,” says Ilmira Gazizova.
Associate Professor Jamilya Lovpache (Moscow) told her colleagues about the importance of dynamic monitoring of patients with glaucoma. According to current clinical guidelines, current monitoring differs in patients with stabilized and non-stabilized disease (in the latter case, individual monitoring periods should be used). However, in practice, everything is not so simple. “To understand whether a patient has a stabilized course or not, it is necessary to observe him at least once every six months, and they can be crucial for visual function. Glaucoma “does not play by the rules” and often “does not allow you to win.” The main goal is to preserve visual functions, for which the doctor first of all chooses the tactics of reducing the level of ophthalmotonus. But, according to statistics, we are wrong in a third of cases when a patient with the second or third stage of the disease comes to us – in this situation, the struggle should go for every millimeter of mercury. In the vast majority of cases, we detect advanced and advanced stages of glaucoma for the first time, and in more than 40% of patients, the disease progresses by one stage in 3-4 years. If the patient does not follow the doctor’s recommendations, the period of transition from stage to stage is reduced to 2.5 years. In addition, some patients lose their sight due to the passive position of the doctor, who is waiting for a miracle and does not change therapy. Compliance (adherence to treatment) is an underestimated aspect. We think that 50% of patients are compliant and treated 200 days a year. And the patients themselves consider themselves highly compliant only in 1.2% (!) of cases. The aspect of tolerability of treatment is also important. The patient is sometimes observed in three institutions, he is prescribed three treatment regimens, and he randomly changes them due to poor tolerance. During the known five phases, common to all chronic diseases and which all patients go through, ours can simply get lost. I am for individual follow-up periods immediately, then adherence will allow us to be partners with patients,” notes Jamilya Lovpache.
Doctor of Medical Sciences Elena Karlova from Samara spoke about the struggle for a 54-year-old patient who underwent several surgical interventions (needling) on each eye. As a result of the hard work of both the doctor and the patient (he is highly mobile and highly motivated for a good result), good results have been achieved. “But we still don’t operate enough, we need a paradigm shift,” says Dr. Karlova.
Professor Igor Ioshin (Moscow) shared his experience of new surgical interventions — micropulse cyclophotocoagulation — in patients with refractory glaucoma. “The number of patients we treat this way is growing. In two years, we have performed more than 300 operations on people with various stages of the disease and received about 73% of people with process compensation: intraocular pressure decreases, the number of drugs is reduced. We have already developed a standard of intervention, the procedure is promising, and it can be used repeatedly,” says Igor Ioshin.
Alexander Kuroyedov made a presentation on alternative treatment tactics in patients with glaucoma. Back in 2012, a scientific publication on neuroprotective therapy for glaucoma was published, its author is Professor Evgeny Egorov, President of the Russian Geographical Society. At that time, the world community was wary of this method, but it has been proven that neuroprotection slows down the loss of retinal ganglion cells and restores lost cells. Today, as an alternative therapy for glaucoma, doctors have begun to use peptide bioregulators. According to Kuroyedov, patients who received them with the initial and advanced stages of the disease recorded a significant increase in visual acuity, a significant increase in visual fields. “The effect on the structure of the eye is positive, the drugs show a neuroprotective effect. And there is a potential for using this group of drugs,” says Alexander Kuroyedov.
Colleagues from Krasnoyarsk (Ph.D. V.V. Garkovenko) and Nizhny Novgorod (candidate of medical sciences S.N. Svetozarsky). It is this experience that becomes in the future one more step towards victory over glaucoma.
Dr. Dmitry Dorofeev from Chelyabinsk shared his experience of treating a young (23 years old) patient with an advanced stage of pigmentary glaucoma. He came to the doctor with pronounced changes in structural parameters, but as a result of complex treatment, the level of eye pressure rose. Unfortunately, congenital glaucoma remains one of the main causes of low vision and blindness in children. The main method of treatment is surgical. The doctor spoke about a patient born in 2016 who underwent shunt implantation and saved his eyesight.
The sad story of a 75-year-old patient was told by Moscow doctor Daria Baryshnikova: for many years the man was diagnosed with cataracts and increased intraocular pressure, but for some reason doctors did not suspect he had glaucoma until his vision began to drop sharply. Now doctors are doing everything possible, but the chances of saving vision are minimal.
Unfortunately, glaucoma causes nightmares not only on Halloween – doctors deal with such patients every day. They urge people not to neglect annual examinations by an ophthalmologist, and colleagues – to be as attentive to patients as possible.
Newspaper headline:
Sector of the eye
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