All about glaucoma. Regional Glaucoma Center Glaucoma Center

Department staff

Term glaucoma combines a large group of diseases characterized predominantly by a chronic course, the development of progressive atrophy of the optic nerve, a change in visual fields, a decrease in visual functions and a disorder in the regulation of intraocular pressure.
Glaucoma is a common disease that often leads to permanent blindness, low vision and disability. A person suffering from glaucoma may not even be aware that he has the disease. The most common types of glaucoma are:

Primary open-angle glaucoma (POAG)
The most common (up to 80% of the total) type of glaucoma. This is a chronic disease that usually affects both eyes (not always at the same time); at the same time, intraocular pressure (IOP) increases gradually as degenerative changes in the drainage zone of the eye develop. Main signs: increased IOP >21 mm Hg, damage to the optic nerve and characteristic changes in visual fields. Risk factors for development: older age group (60 years or more), female sex, the presence of the disease in blood relatives, myopia (nearsightedness).

Normotension glaucoma
It is manifested by characteristic damage to the optic nerve and visual fields against the background of a normal level of IOP (10-20 mm Hg). The reasons for the development of such a pathological condition are considered to be a violation of vascular regulation, low blood pressure (especially in the morning), autoimmune diseases, pathology of the blood coagulation system, genetic predisposition, and so on.

Primary angle-closure glaucoma
In this type of glaucoma, IOP increases due to partial or complete blockade of the drainage system of the eye by the root of the iris. It is customary to allocate chronic, subacute and acute course of the disease. The last two are a condition requiring immediate medical attention. Risk factors: older age group (60 years or more), female gender, the presence of the disease in blood relatives, hypermetropic refraction (farsightedness).

Secondary glaucoma
A group of diseases in which an increase in IOP and the development of corresponding changes in the optic nerve is a consequence of a previous disease or traumatic injury to the eye. The most common forms of secondary glaucoma are: neovascular (after violations of the patency of the retinal vessels, against the background of severe forms of diabetes mellitus), in which the drainage zone is closed by newly formed vessels and a fibrovascular membrane; post-traumatic (with a change in the location and damage to the anatomical structures of the eyeball), inflammatory (against the background of a long-term chronic inflammatory process in the eye), as well as with intraocular volumetric neoplasms, pseudoexfoliative syndrome, due to prolonged systemic administration or local instillations of hormonal drugs (corticosteroids).

congenital glaucoma
A relatively rare pathology (1 per 10-20 thousand newborns), characterized by the presence of a congenital anomaly in the development of the drainage zone of the eyeball. In 75% of cases, the disease is bilateral. An increase in IOP develops in 40% of cases in utero, in 55% during the first three years of life, and in 5% from 3 to 16 years of age. Congenital glaucoma is more common in males.

Diagnostic methods

Diagnosis of glaucoma

It is now recognized that glaucoma is a complex disease with a variety of causes and clinical manifestations. Therefore, it is diagnostics that plays a key role in the correct formulation of an individual diagnosis and the development of an optimal treatment plan. It is difficult to diagnose the earliest manifestations of glaucoma.
Examination for glaucoma is a set of studies that includes the following main items:
Eye examination;
Assessment of intraocular pressure;
Study of the field of view;
Assessment of the condition of the optic nerve head.
Our Institute has all the necessary modern equipment for the diagnosis of glaucoma.

Assessment of intraocular pressure (tonometry)

Pneumotonometry
In most cases, patients with glaucoma do not present any complaints. That is why each patient who applied to the institute is measured intraocular pressure.
Pneumotonometers, which allow you to quickly determine the pressure in a non-contact way, are optimal for this. They are also used when it is not possible to use contact methods for measuring IOP.

Tonometry according to Goldman
This technique of tonometry is recognized abroad. The device has a minimal effect on the eye - about 2-3 grams. The study is carried out while sitting at the slit lamp.

Tonometry according to Maklakov
An anesthetic drops are instilled into the patient's eyes, then a Maklakov tonometer is placed on the eye. The ends of the tonometer are polished plates 1 cm in diameter. They are covered with a thin layer of paint from collargol, glycerin and distilled water. The patient lies face up on the couch, the doctor stands at the head of the patient, pushes the eyelids of the right eye apart with his left hand, and lowers the tonometer to the center of the cornea with his right hand. The load presses on the cornea, the paint from it passes to it, remaining only along the edge of the tonometer platform. The measurement results are transferred to paper in the form of prints of tonometer pads. After completion of the study, antibacterial drops are instilled to prevent infectious complications.

Measurement of corneal-compensated IOP(analyzer of the biomechanical properties of the cornea, "glaucoma" tonometer Reichert 7CR)
All tonometers determine the level of intraocular pressure by acting on the shell of the eye. However, the fact that its thickness and mechanical properties are not the same in all patients is not always taken into account! In some cases, this leads to erroneous high pressure results, in others, which is even more dangerous, to an underestimation of tonometry data, which masks glaucoma, and the eye may lose visual function without proper treatment.
This problem can be solved by the analyzer of the biomechanical properties of the cornea, which uses a fast air pulse and a special electron-optical system for the simultaneous determination of pressure, taking into account the individual characteristics of the eye. The assessment is based on 400 corneal pressure and strain values ​​determined in one measurement.

Examination of the visual field (perimetry)
Increased intraocular pressure damages the retina. However, at first it occurs in its peripheral parts, which usually does not cause complaints. Pay attention to the decrease in vision with damage to the central zone, when it is almost impossible to restore vision.
Therefore, it is so important to determine the degree of violation in the early stages of the disease! This can be done by examining the field of view.

Computer perimetry on the visual field analyzer
Since the 90s of the last century, the study of visual fields using the Humphrey analyzer has been considered the standard in the diagnosis and dynamic monitoring of patients with glaucoma.
From year to year, developers modify the device to increase the accuracy and speed of the examination. There are 7 modern computer perimeters in our institute. Studies are carried out by highly qualified specialists, the analysis results are automatically archived in the instrument's database.

Laser and optical coherence tomography of the optic nerve and retina
Retinal tomography - examination of the layer of nerve fibers of the retina and optic nerve using a "laser microscope". With the help of retinotomography, it is possible to diagnose glaucoma at a very early stage, when there are no changes in other examinations.
The study is carried out contactlessly in a short period of time. For this purpose, the Research Institute of Eye Diseases uses the latest generation of devices that perform automatic analysis of the probability of glaucoma damage.

Ultrasound examination of the vessels of the orbit
To date, only modern ultrasound methods allow us to see and evaluate the functional state of the vessels that supply the eye with blood.
Safety and high information content make these studies the most accessible. Our institute is equipped with modern and high-tech ultrasound equipment, which combines a combination of all the necessary modes for examining orbital vessels. The result of an ultrasound examination in some cases can be a decisive moment in the diagnosis, choice of treatment tactics and subsequent monitoring of the results obtained during treatment.

Medical treatment

Drug treatment of glaucoma is carried out in three main areas:
1. Decreased intraocular pressure. Currently, there is a wide arsenal of tools used to reduce the level of intraocular pressure. Their selection is carried out strictly individually, taking into account the condition of the eye and concomitant pathology.
2. Therapy that improves blood circulation in the inner membranes of the eye and optic nerve.
3. Therapy aimed at normalizing metabolism in the tissues of the eye in order to influence the degenerative processes characteristic of glaucoma.
With the ineffectiveness of drug therapy, the issue of laser or surgical treatment is decided.

Laser treatment of glaucoma

Laser treatments for glaucoma have been widely used for over 30 years.
Their undoubted advantage is the ability to perform subtle microsurgical interventions on the membranes of the eye without opening the eyeball, which avoids serious complications. An important advantage of laser interventions is the restoration of the outflow of intraocular fluid through natural channels. In addition, they are performed on an outpatient basis under local anesthesia (drops).
In case of a low effect of laser intervention, traditional surgical treatment is possible. The modern equipment of our institute allows us to perform all known laser interventions: laser trabeculoplasty, selective laser trabeculoplasty, laser iridectomy, transscleral cyclocoagulation.

Surgical treatment of glaucoma

Surgical treatment should be resorted to in cases where it is not possible to normalize intraocular pressure and preserve visual functions by other means.
For this purpose, additional ways of outflow of fluid from the eye cavity are created.
Normally, the fluid drains through a special drainage system inside the eye. When the functioning of these structures is impaired, and the pressure does not decrease with drops, they resort to restoring these pathways surgically.
There are 3 main types of operations: penetrating operations, non-penetrating operations, and the use of drains and drainage devices.
Penetrating type operations include an operation associated with the removal of a microscopic piece of the drainage zone and the formation of a fistula. It is believed that this operation is the longest and most effective in reducing intraocular pressure, due to which it has become the most widespread in the world. The operation is performed in a hospital, the hospitalization period is 7 days.
A non-penetrating type of operation is a non-penetrating deep sclerectomy. It consists in partial excision and thinning of the same tissue area as in penetrating operations, however, in this case, a full-fledged hole is not formed, and fluid flows out of the anterior chamber of the eye through the thinnest film formed. The hypotensive effect in this case is less pronounced and not so long, but the likelihood of certain complications is much lower.
Implantation of microscopic drainage devices is necessary when conventional surgery is likely to be ineffective or ineffective: secondary glaucoma, previous unsuccessful surgical interventions. All drainage devices have the same goal - to reduce intraocular pressure by improving outflow.
The employees of the Glaucoma Department have all the skills of surgical treatment of glaucoma.

Glaucoma is a progressive disease leading to irreversible blindness. In connection with increased intraocular pressure in glaucoma, retinal cells are destroyed, the optic nerve atrophies, and visual signals cease to flow to the brain. A person begins to see worse, peripheral vision is disturbed, as a result of which the visibility zone is limited.

Mentions of glaucoma (translated from Greek, this word means "green color of the sea") are found in the works of Hippocrates, dated 400 BC. However, modern ideas about glaucoma began to take shape only in the middle of the 9th century.

Currently, glaucoma is understood as a rather large group of diseases, often of different origin and with different course. There is still no consensus on what causes the development of these ailments, but if left untreated, their outcome is the same - optic nerve atrophy and blindness.

How does a person with glaucoma see?

Glaucoma

normal vision

Risk groups for glaucoma include:

• people over 60-70 years old who do not even complain about their eyes;
• people over 40 who:
  • intraocular pressure is in the upper limit of normal;
  • the difference between the intraocular pressure of the right and left eyes is more than 5 mm Hg. Art.;
  • the difference between intraocular pressure measured in the morning and in the evening is more than 5 mm Hg. Art.;
• people with a high degree of myopia after 40-50 years, with a high degree of hyperopia (especially women after 50 years);
• people with increased intraocular pressure, regardless of age;
• people with low (relative to the age norm) blood pressure;
• people with diabetes, endocrine, nervous and cardiovascular diseases;
• people who have had eye injuries, inflammatory diseases (uveitis, iridocyclitis, etc.) of the eyes, eye surgery;
• relatives (including distant ones) of patients with glaucoma with similar structural features of the eye;
• people undergoing long-term treatment with hormonal drugs.

Glaucoma can occur at any age, but it is most common in older people.

Age groups

newborns

Disease frequency

1 case of glaucoma in about 10,000 newborns.

Primary glaucoma is diagnosed in about 0.1% of the population.

In this age group, glaucoma occurs in approximately 1.5-2% of cases.

According to the World Health Organization, glaucoma is a major disease that, if left untreated, irreversibly causes blindness. More than 5 million people have lost their sight due to glaucoma, which is 13.5% of all blind people in the world.

Reasons for the development of glaucoma

A certain pressure (18-22 mmHg) is constantly maintained in a healthy eye due to the balance of fluid inflow and outflow. In glaucoma, this circulation is disrupted, fluid accumulates, and intraocular pressure begins to rise. The optic nerve and other structures of the eye experience an increased load, the blood supply to the eye is disturbed. As a result, the optic nerve atrophies, and visual signals cease to flow to the brain. A person begins to see worse, peripheral vision is impaired, as a result of which the visibility zone is limited - and as a result, blindness may occur.

Glaucoma is an irreversible disease. Therefore, it is very important to start treatment on time.

The main symptoms of glaucoma are:

• pain, pain, feeling of heaviness in the eyes, narrowing of the field of vision;
• blurred vision, the appearance of a "grid" before the eyes;
• when looking at a bright light, for example, at a lamp, “rainbow circles” appear before the eyes;
• deterioration of vision in the evening and at night;
• feeling of moisture in the eye;
• slight pain around the eyes;
• redness of the eyes.

Forms of glaucoma

• Open angle glaucoma
• Angle-closure glaucoma

open-angle form is diagnosed in more than 90% of cases of glaucoma. In open-angle glaucoma, access to the natural drainage system is open, but its functions are impaired. The result is a gradual increase in intraocular pressure. As a rule, open-angle glaucoma is characterized by an asymptomatic, almost imperceptible course of the disease. Since the field of vision narrows gradually (the process can continue for several years), a person sometimes quite by accident discovers that he sees only one eye. In some cases, it is possible to identify complaints about the periodic appearance of iridescent circles when looking at a light source, "fogging", asthenopic complaints associated with a weakening of accommodation.

At angle-closure glaucoma intraocular fluid accumulates due to the fact that there is no access to the natural drainage system of the eye - the iris blocks the angle of the anterior chamber. As a result, the pressure builds up, and this can lead to an acute attack of glaucoma, which is accompanied by:

• sharp pain in the eye and the corresponding half of the head;
• obvious visual disturbances (blurring of vision or its sharp decrease up to complete blindness);
• redness of the eye (expansion of the vessels of the anterior segment of the eyeball), swelling of the cornea, a decrease in the depth of the anterior chamber, pupil dilation and the absence of its reaction to light;
• the appearance of halos around light sources.

Ophthalmologists draw attention to the fact that as a result of an acute attack of glaucoma, a sudden loss of vision is possible.

Diagnosis of glaucoma

To detect the onset of the disease, a simple measurement of intraocular pressure is not enough. It is necessary to study in detail the fundus and the optic nerve head, as well as to examine the visual fields, that is, to conduct a thorough diagnostic examination.

In the Excimer ophthalmological clinics, the examination is performed using a whole range of modern computerized equipment and includes:

• examination of the visual field (using a computer perimeter);
• measurement of refraction (the ability of the optical system of the eye to refract light rays);
• measurement of intraocular pressure;
• ultrasound examinations;
• determination of the depth of the anterior chamber of the eye and the thickness of the lens (since often the cause of high pressure is a displacement or enlargement of the lens);
• using gonioscopy, the structure of the angle of the anterior chamber is evaluated, through which the outflow of fluid from the eye is carried out.

Also, during the diagnostics, an examination is necessarily carried out on the computer perimeter and on the fundus analyzer - a unique device that is available in the equipment of a few Russian clinics. This allows you to identify the initial manifestations of glaucoma that occur before changes in the field of view, and in time to stop the pathological process that has begun.

Expert opinion

Ophthalmologist of the highest category

Glaucoma is surrounded by a huge number of rumors and just as many misconceptions. Some believe that only the elderly are at risk, others are sure that it is impossible to miss the first symptoms of the disease, and still others try to be treated on their own, prescribing drops to lower intraocular pressure or using folk remedies.

As a result, it turns out that the patient reaches the appointment of an ophthalmologist already in a state far from the initial stage of the pathological process. Changes that occur in the patient's eye before contacting the clinic, unfortunately, can be irreversible. That is why we recommend regular examination of the organ of vision for each patient, regardless of whether he has complaints or visible symptoms of the disease.

How to deal with glaucoma?

Remember, without timely detection of the disease and timely treatment, vision is irretrievably lost! The Excimer Clinic offers its patients the most advanced and reliable methods for diagnosing and treating glaucoma. Do not delay treatment, do not risk the health of your eyes!

Cost of basic services

- a group of chronic eye diseases of various origins. Today, glaucoma in Russia and the world is one of the leading causes of blindness or visual impairment.

A common feature for all diseases is the main symptom of glaucoma - an increase in intraocular pressure, accompanied by impaired blood supply to tissues and the optic nerve. This pathology leads to a gradual change in the structure of the internal media of the eye and the appearance of visual field defects. In the advanced stages of glaucoma, visual field defects begin to merge, forming "tubular vision", in the terminal stage, as a rule, optic nerve atrophy and complete blindness occur.

The insidiousness of glaucoma is that even in the late periods of development, high visual acuity is preserved, but the disease is detected by chance, when the fellow eye is excluded from the visual process.

Glaucoma can be detected at any age (including in newborns), but the greatest risk of developing this disease occurs at retirement age. According to statistics, at the age of 45 years, glaucoma is diagnosed, as a rule, in 0.1% of cases, by the age of 65 these figures increase 15 times and amount to 1.5%, and after 75 years they already reach 3% and more.

Signs of glaucoma

The main problem in the treatment of glaucoma is the untimely appeal of patients to the doctor. It is due to the absence of any objective complaints in patients for a rather long time of the development of the disease, up to the onset of severe complications, and sometimes irreversible changes in the tissues of the eye.

However, there are signs of glaucoma, you just need to be able to listen to your body. Especially often with glaucoma, patients complain of vision, a feeling of heaviness in the eyes, pain behind the eye or in the superciliary region, narrowing of the field of vision. In addition, twilight vision deteriorates significantly, and when looking at a light source, “rainbow circles” appear before the eyes.

Without treatment, the loss of visual functions in this disease is almost irreversible, so early diagnosis of glaucoma is a real chance to preserve vision. A preventive measure for diagnosing glaucoma can be a simple measurement of intraocular pressure: at 35-40 years old - once a year, after 55 years - at least twice a year. If abnormalities are detected, a complete ophthalmological examination is required.

Video about the causes, diagnosis and treatment of glaucoma

Glaucoma treatment

The goal of glaucoma treatment is to improve the blood supply to the eye and reduce the level of high intraocular pressure to acceptable values ​​(this indicator is called the tolerant level and can vary significantly in different patients).

Treatment of glaucoma includes three stages: at the first, conservative drug therapy is used (eye drops - Betoptik, Xalatan, Timolol, Travatan, etc.). The lack of significant compensation for intraocular pressure makes it necessary to use laser methods of exposure (, descemetogoniopuncture, etc.) or surgical intervention (non-penetrating deep, sinustrabeculectomy, etc.).

Cost of treatment

In most eye clinics in Moscow, the cost of treatment is determined individually and largely depends on the type of disease and its stage, as well as the research results already available, etc.

A comprehensive examination for glaucoma, including all the necessary diagnostic methods, is from 3,500 rubles.
Prices for laser treatment of glaucoma start from 5,000 rubles, and for surgical interventions - from 15,000 rubles.

The best eye clinics in Moscow where glaucoma is treated

- a chronic pathology of the eyes, characterized by an increase in intraocular pressure, the development of optic neuropathy and impaired visual function. Clinically, glaucoma is manifested by narrowing of the visual fields, pain, pain and a feeling of heaviness in the eyes, blurred vision, deterioration of twilight vision, and in severe cases, blindness. Diagnosis of glaucoma includes perimetry, tonometry and tonography, gonioscopy, optical coherence tomography, laser retinotomography. Treatment of glaucoma requires the use of antiglaucoma drops, the use of laser surgery methods (iridotomy (iridectomy) and trabeculoplasty) or antiglaucomatous operations (trabeculectomy, sclerectomy, iridectomy, iridocycloretraction, etc.).

ICD-10

H40-H42

General information

Glaucoma is one of the most formidable diseases of the eye, leading to loss of vision. According to available data, glaucoma affects about 3% of the population, and in 15% of blind people worldwide, glaucoma has caused blindness. At risk for the development of glaucoma are people over 40 years old, however, in ophthalmology there are such forms of the disease as juvenile and congenital glaucoma. The frequency of the disease increases significantly with age: for example, congenital glaucoma is diagnosed in 1 out of 10-20 thousand newborns; in the group of 40-45-year-old people - in 0.1% of cases; in 50-60-year-olds - in 1.5% of observations; after 75 years - in more than 3% of cases.

Glaucoma is a chronic eye disease that occurs with a periodic or constant increase in IOP (intraocular pressure), disorders of the outflow of intraocular fluid (intraocular fluid), trophic disorders in the retina and optic nerve, which is accompanied by the development of visual field defects and marginal excavation of the ONH (optic nerve head) . The concept of "glaucoma" today combines about 60 different diseases with the listed features.

Reasons for the development of glaucoma

The study of the mechanisms of glaucoma development allows us to speak about the multifactorial nature of the disease and the role of the threshold effect in its occurrence. That is, for the occurrence of glaucoma, the presence of a number of factors that together cause the disease is necessary.

The pathogenetic mechanism of glaucoma is associated with a violation of the outflow of intraocular fluid, which plays a key role in the metabolism of all structures of the eye and maintaining a normal level of IOP. Normally, the aqueous humor produced by the ciliary (ciliary) body accumulates in the posterior chamber of the eye - a slit-like space located behind the iris. 85-95% of the intraocular fluid flows through the pupil into the anterior chamber of the eye - the space between the iris and the cornea. The outflow of intraocular fluid is provided by a special drainage system of the eye, located in the corner of the anterior chamber and formed by the trabecula and Schlemm's canal (venous sinus of the sclera). VOG flows through these structures into the scleral veins. An insignificant part of the aqueous humor (5-15%) flows out by an additional uveoscleral route, seeping through the ciliary body and sclera into the venous collectors of the choroid.

To maintain normal IOP (18-26 mmHg), a balance is needed between the outflow and inflow of aqueous humor. In glaucoma, this balance is disturbed, as a result of which an excessive amount of intraocular fluid accumulates in the eye cavity, which is accompanied by an increase in intraocular pressure above the tolerant level. High IOP, in turn, leads to hypoxia and ischemia of the eye tissues; compression, gradual dystrophy and destruction of nerve fibers, disintegration of retinal ganglion cells and, ultimately, to the development of glaucomatous optic neuropathy and optic nerve atrophy.

The development of congenital glaucoma is usually associated with eye abnormalities in the fetus (anterior chamber angle dysgenesis), trauma, and eye tumors. A predisposition to the development of acquired glaucoma exists in people with a burdened heredity for this disease, people suffering from atherosclerosis and diabetes mellitus, arterial hypertension, cervical osteochondrosis. In addition, secondary glaucoma can develop as a result of other eye diseases: farsightedness, occlusion of the central retinal vein, cataracts, scleritis, keratitis, uveitis, iridocyclitis, progressive iris atrophy, hemophthalmos, eye injuries and burns, tumors, surgical interventions on the eyes.

Classification of glaucoma

By origin, primary glaucoma is distinguished as an independent pathology of the anterior chamber of the eye, drainage system and ONH, and secondary glaucoma, which is a complication of extra- and intraocular disorders.

In accordance with the mechanism underlying the increase in IOP, closed-angle and open-angle primary glaucoma are distinguished. In angle-closure glaucoma, there is an internal block in the drainage system of the eye; with an open-angle form - the angle of the anterior chamber is open, however, the outflow of intraocular fluid is impaired.

Depending on the level of IOP, glaucoma can occur in a normotensive variant (with a tonometric pressure of up to 25 mm Hg) or a hypertensive variant with a moderate increase in tonometric pressure (26-32 mm Hg) or high tonometric pressure (33 mm Hg). article and above).

Along the course, glaucoma can be stabilized (in the absence of negative dynamics within 6 months) and unstabilized (with a tendency to changes in the visual field and optic disc during repeated examinations).

According to the severity of the glaucoma process, 4 stages are distinguished:

• I(the initial stage of glaucoma) - paracentral scotomas are determined, there is an expansion of the optical disc, excavation of the optic disc does not reach its edge.
• II(stage of advanced glaucoma) - the field of view is changed in the parcentral region, narrowed in the lower and / or upper temporal segment by 10 ° or more; excavation of the ONH is of a regional character.
• III(stage of advanced glaucoma) - there is a concentric narrowing of the boundaries of the field of view, the presence of marginal subtotal excavation of the optic disc is revealed.
• IV(terminal stage of glaucoma) - there is a complete loss of central vision or the preservation of light perception. The condition of the ONH is characterized by total excavation, destruction of the neuroretinal rim, and shift of the vascular bundle.

Depending on the age of onset, glaucoma is classified into congenital (in children under 3 years old), infantile (in children from 3 to 10 years old), juvenile (in people aged 11 to 35 years old) and adult glaucoma (in persons over 35 years of age). In addition to congenital glaucoma, all other forms are acquired.

Symptoms of glaucoma

An integral part of the examination for glaucoma is perimetry - determination of the boundaries of the field of view using various techniques - isoptopperimetry, campimetry, computerized perimetry, etc. Perimetry allows you to detect even initial changes in visual fields that are not noticed by the patient himself.

The state of the ONH is the most important criterion for assessing the stage of glaucoma. Therefore, the complex of ophthalmological examination includes ophthalmoscopy - a procedure for examining the fundus. Glaucoma is characterized by deepening and expansion of the vascular funnel (excavation) of the optic disc. In the stage of advanced glaucoma, marginal excavation and discoloration of the optic disc are noted.

A more accurate qualitative and quantitative analysis of structural changes in the optic disc and retina is performed using laser scanning ophthalmoscopy, laser polarimetry, optical coherence tomography or Heidelberg laser retinotomography.

Glaucoma treatment

There are three main approaches to the treatment of glaucoma: conservative (drug), surgical and laser. The choice of treatment tactics is determined by the type of glaucoma. The objectives of drug treatment of glaucoma are to reduce IOP, improve blood supply to the intraocular optic nerve, and normalize metabolism in the tissues of the eye. According to their action, antiglaucoma drops are divided into three large groups:

1. Drugs that improve the outflow of intraocular fluid: miotics (pilocarpine, carbachol); sympathomimetics (dipivefrin); prostaglandins F2 alpha - latanoprost, travoprost).
2. Means that inhibit the production of intraocular fluid: selective and non-selective ß-blockers (betaxolol, betaxolol, timolol, etc.); a- and β-blockers (proxodolol).
3. Combined drugs.

With the development of an acute attack of angle-closure glaucoma, an immediate decrease in IOP is required. The relief of an acute attack of glaucoma begins with the instillation of miotic - 1% of the solution of pilocarpine according to the scheme and the solution of timolol, the appointment of diuretics (diacarb, furosemide). Simultaneously with drug therapy, distracting events are carried out - setting cans, mustard plasters, leeches on the temporal region (hirudotherapy), hot foot baths. Laser iridectomy (iridotomy) or basal iridectomy by a surgical method is necessary to remove the developed block and restore the outflow of intraocular fluid.

Methods of laser surgery for glaucoma are quite numerous. They differ in the type of laser used (argon, neodymium, diode, etc.), the method of exposure (coagulation, destruction), the object of exposure (iris, trabecula), indications for performing, etc. In laser surgery for glaucoma, laser iridotomy and iridectomy, laser iridoplasty, laser trabeculoplasty, laser goniopuncture. In severe degrees of glaucoma, laser cyclocoagulation may be performed.

Have not lost their relevance in ophthalmology and antiglaucomatous surgery. Among the fistulizing (penetrating) operations for glaucoma, the most common are trabeculectomy and trabeculotomy. Non-fistulizing interventions include non-penetrating deep sclerectomy. Operations such as iridocycloretraction, iridectomy, etc. are aimed at normalizing the circulation of intraocular fluid. In order to reduce the production of intraocular fluid in glaucoma, cyclocryocoagulation is performed.

Prediction and prevention of glaucoma

It must be understood that it is impossible to completely recover from glaucoma, but this disease can be kept under control. At an early stage of the disease, when irreversible changes have not yet occurred, satisfactory functional results in the treatment of glaucoma can be achieved. The uncontrolled course of glaucoma leads to irreversible loss of vision.

Prevention of glaucoma consists in regular examinations by an ophthalmologist of persons at risk - with a burdened somatic and ophthalmological background, heredity, over 40 years old. Patients suffering from glaucoma should be registered with an ophthalmologist, regularly visit a specialist every 2-3 months, and receive recommended treatment for life.

Indications for surgical intervention are a whole range of disorders that can subsequently affect visual acuity. People of several categories are at risk: the elderly, suffering from changes in intraocular pressure or its constant elevated levels, with a high degree of myopia (nearsightedness), suffering from diabetes, having endocrine, cardiovascular and nervous diseases, who have undergone injuries of the organ of vision, surgical interventions and have a history of frequent inflammatory diseases of the eyes.

There are two main forms of glaucoma - open-angle and closed-angle. In the first case, the natural drainage system of the eye is not subject to change, however, the mechanism of its work is broken. This form of glaucoma is the most common.

In a more complex form of the disease (angle-closure), the drainage system of the visual analyzer is deformed and does not perform its functions. The closed-angle form is characterized by the appearance of acute attacks of glaucoma or a sharp increase in intraocular pressure.

Treatment

Treatment of glaucoma can occur in three sequential scenarios, which can be used in combination with each other.

Conservative treatment

This method involves the use of drugs that reduce intraocular pressure. They act in two main directions: reduce the production of intraocular fluid or increase the outflow rate. Combined drugs combine these two properties.

Laser correction

Laser therapy is used for both open-angle and closed-angle forms of the disease and is most effective in the uncomplicated course of the disease and in its early stages. It implies the additional use of drugs and constant monitoring by an ophthalmologist.

Surgery

This method is radical and most effective. During the surgical operation, depending on the form of the disease, as well as its degree of development, the drainage system of the visual analyzer is normalized by creating an artificial outflow pathway for intraocular fluid or implanting drainage. The general range of eye surgery services for glaucoma also includes revision of the filtration cushion, as well as needleling (postoperative revision of the filtration zone). The cost of antiglaucoma surgery depends on the volume and type of surgical intervention, as well as anesthesia support. See prices on the website.

Price

The cost of getting rid of the manifestations of glaucoma varies depending on the form and degree of the disease, the general health of the patient and the risks associated with surgery. The total cost consists of preparation for the operation, which includes all diagnostic tests and medical support, the operation itself and recovery measures. Prices on the website of the clinic are indicated without taking into account the accompanying examinations and drug therapy, which the patient needs after the intervention.

Advantages

Surgical solution of the problem is not only the fastest way, but also the most effective. The intervention occurs in isolation and does not affect other body systems, because in the future it does not require constant medication to maintain normal intraocular pressure. The rehabilitation period is from one to three weeks. The list of restrictions is minimal.

Glaucoma is an inevitable blindness that is important to prevent. A few thousand is a small price to pay for the opportunity to see the world around us in full.