Vol 7, No 3 (2014)

The analysis of 5-year material on patient population characteristics in the federal phthisioophthalmological sanatorium (4284 patients) demonstrates an insufficient prophylactic health assessment of patients as well as a high recurrence rate of ocular tuberculosis in the Russian Federation. The analysis of treatment results in the sanatorium based on data of 140 patients from the follow-up monitoring group 1 with terms of treatment on the preceding stage not exceeding 2 months allowed revealing significant fault reasons. In dispensaries, a treatment process not considering sub-groups (newly diagnosed process, or recurrence) was found, as well as insufficient period and amount of chemotherapy, insufficient number of phtisioophthalmologists, lack of specialized ophthalmological beds in tuberculosis clinics, etc. The efficacy of recommended methods is confirmed, which take into consideration the peculiarities of ocular tuberculosis therapy, as well as the regulations of the Order Health Care Ministry of the Russian Federation approved in 2003. In the conclusions, the necessity to improve the organization of medical and diagnostic care for ocular tuberculosis patients and to publish corresponding federal guidelines is presented.

Achievements in primary open-angle glaucoma (POAG) treatment unfortunately do not ensure an adequate neuroprotective effect in monotherapy of the disease that is why a search for effective and affordable neuroprotectors continues. The aim of the study was to assess the neuroprotective effect of herbal medicinal product “Tanakan” in treatment of POAG patients with normalized intraocular pressure. Methods. A complex clinical and morphological randomized crossover study. Thirty patients (57 eyes) with established stage I-II POAG were examined. Results. During the period from no treatment, up to 3 and 6 months from the treatment start, a reliable increase of the Jantch index (Jantch, 1958) was noted. A positive trend in values of electrophysiological indices was revealed: macular ERG (MERG) a-wave amplitude, and rhythmic ERG (RERG) a-wave amplitude increased. A positive dynamics was found when performing vacuum tests with dosated intraocular pressure (IOP) increase: p-100 complex amplitude increase without its latency changes, as a result of vacuum-compression test with visual evoked cortical potentials (VCT with VECP); with laser confocal tomography, a decrease of maximal optic disc excavation depth at maximal vacuum load was established. Conclusions. An increase of functional visual analyzer performance capabilities at the 1st, 2nd and 3rd neurons level without any changes in optic disc morphometric parameters could be qualified as a neuroprotective effect of the treatment. The increase in the Jantch index, as well as the decrease of maximal optic disc excavation depth as a result of artificial IOP increase may be qualified as an increase in optic nerve tolerance. Tanakan could be used complementary, as a neuroprotector, in combined therapy in stage I-II POAG patients at normalized IOP as long-term (up to 6 months) therapy courses.

The last decades have seen an increase of steroid use in ophthalmology to treat various diseases. These include allergic conjunctivitis, uveitis of different etiologies, age-related macular degeneration, central serous retinopathy, and post-operative complications, etc. In addition, recently, ophthalmologists have noted an increasing frequency of uncontrolled steroid use by patients. This could lead to ocular hypertension and steroid induced glaucoma. Recent data on prevalence, causes and pathogenesis of steroid induced glaucoma are presented in the article.

Retinal OCT measurements were analyzed after phacoemulsification with intraocular lens (IOL) implantation in primary open-angle glaucoma (POAG) patients. A total of 190 patients (205 eyes) were examined. Two different groups were analyzed. Patients in Group 1 (32 eyes) had been treated with prostaglandin analogs before surgery (phacoemulsification or phacoemulsification + pressure lowering procedure) and after it when needed. However, these drops were stopped one day prior to surgery. Patients in Group 2 (173 eyes) were used as the control. The mean follow-up period after surgery was 12 months. During the entire follow-up period, in all patients had OCT monitoring at the 2nd-3rd day after surgery, 1 month, 2 months, 6 months, and 12 months. The OCT measurements were not statistically different between Group 1 (32 eyes) and Group 2 (173 eyes). According to our results, there was no significant influence of pre-operative prostaglandin use on the retinal thickness when compared to patients not using this therapy.

Vogt-Koyanagi-Harada (VKH) disease should be part of the differential diagnosis of a bilateral granulomatous uveitis. VKH is more common in the Mongoloid race (most frequently in Japanese, American Indians), and people of Hispanic descent. In Europeans, it is rare; mostly in women aged 30-50 with dark skin and hair pigmentation. The prodromal stage of VKH disease is non-specific but may include headache, vomiting and general malaise. Indocyanine green angiography may be helpful in making the diagnosis. Presenting a clinical case, the authors discuss the methods for diagnosis and follow-up for patients with Vogt-Koyanagi-Harada disease. Effective and timely treatment with high dose corticosteroids, if necessary in combination with immunosuppression, could save good visual functions.