The best eye clinics in the treatment of glaucoma. All about glaucoma Center for treatment and diagnosis of glaucoma


– a group of chronic eye diseases of different 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 - increased intraocular pressure, accompanied by impaired blood supply to the tissues and 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 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 late periods of development, high visual acuity is maintained, 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, before the age of 45, 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 reach 3% and higher.

Signs of glaucoma

The main problem in the treatment of glaucoma is the failure of patients to consult a doctor in a timely manner. It is due to the absence of any objective complaints in patients during a fairly long period of development of the disease, until the onset of severe complications, and sometimes irreversible changes in eye tissue.

However, signs of glaucoma exist; 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 area, and a 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 function in this disease is almost irreversible, so early diagnosis of glaucoma is a real chance to preserve vision. A simple measurement of intraocular pressure can be a preventive measure for diagnosing glaucoma: at 35-40 years old - once a year, after 55 years - at least twice annually. If abnormalities are detected, it is imperative to undergo a full ophthalmological examination.

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 tolerance level and can vary significantly from patient to patient).

Treatment of glaucoma includes three stages: in the first, conservative drug therapy is used (eye drops - Betoptik, Xalatan, Timolol, Travatan, etc.). The lack of significant compensation of intraocular pressure makes it necessary to use laser methods (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 necessary diagnostic methods, costs 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

Glaucoma develops most often in the following cases:

  • In people over 40 years of age
  • If close relatives have glaucoma
  • In patients with diabetes mellitus
  • For farsightedness
  • When working for long periods of time in poor lighting
  • In people suffering from osteochondrosis and vascular diseases

The first signs of glaucoma

  • When you look at a light source, you see a rainbow halo around you
  • Vision begins to decline
  • Red or sore eye

Glaucomatous damage involves the death of retinal nerve cells and optic nerve fibers. As a result, defects appear in the field of vision, invisible to the patient, which later merge into a concentric narrowing. Visual acuity remains high for a long time, this creates a feeling of false well-being, but subsequently, without treatment, rapid and irreversible blindness occurs.

A person with risk factors for developing glaucoma needs to consult an ophthalmologist. If an ophthalmological examination is carried out on time and the disease is detected at an early stage, then, as a rule, the treatment stops the further development of the disease. If the signs of the disease are ignored for a long time, glaucoma begins to progress. A pathological chain reaction of cell death (apoptosis) is triggered in the optic nerve fibers. Therefore, treatment should be aimed not only at reducing intraocular pressure to normal levels, but also at preserving “living” nerve cells.

Diagnosis of glaucoma

Eye examination- painless and safe – necessary at the initial stage of the examination. At the first stage, visual acuity is checked, then the ophthalmologist conducts an examination using a special microscope, which allows you to examine the eye “layer by layer”, and direct ophthalmoscopy to examine the fundus. If during a visual acuity test a concomitant pathology was identified (myopia, farsightedness, astigmatism), the doctor will select glasses or contact lenses for you.

Measuring intraocular pressure- intraocular pressure is measured in a non-contact manner, which prevents the risk of infection and does not require preliminary instillation of an anesthetic.

Tonography- allows you to measure the speed of fluid flowing inside the eye. The method helps determine the cause of the disease - the rate of fluid entering and flowing out of the eye.

Computer perimetry method- to study the state of peripheral vision, the most informative and sensitive method of computer perimetry is used on the Perikom and Octopus devices. In this study, the patient responds to presented light stimuli by pressing a remote control button.

Triplex scanning of eye vessels- used to study the condition of the vessels supplying the eyeball, and helps to exclude a similar disease - chronic ischemic oculopathy. This type of examination is carried out using an ultrasound machine with simultaneous measurement of biometric parameters of the eye.

Optical coherence tomography- neuro-optical module - allows you to detect the loss of nerve cells and determine the progression of the disease in the early stages of the disease.

Glaucoma treatment

Successfully used modern high-tech methods of treating glaucoma allow for a full examination and highly effective treatment in a short time (5-7 days), which is an important factor for active working patients.

After completing the examination and making a diagnosis, the ophthalmologist gives detailed recommendations for the treatment of glaucoma, talks about the influence of occupational factors, lifestyle, nutrition, etc. on the development and course of the disease. The doctor will also determine the frequency of observation for the disease.

At an early stage of glaucoma, drug treatment in the form of drops is prescribed; at a later stage, a course of parabulbar and subconjunctival injections is performed to protect nerve cells.

If the disease cannot be controlled with these methods, laser minimally invasive surgical treatment is performed - trabeculoplasty, iridoplasty, iridectomy.

Even more intensive treatment is carried out in a hospital setting.

Instillation and maintenance therapy- in the initial stages of the disease, it is enough for the patient to instill drops into the eyes and periodically take courses of drugs that support and protect the nerve fibers of the optic nerve.

Parabulbar and subconjunctival injections- are carried out at a deeper stage of the disease and are necessary to deliver the drug in the immediate vicinity of the posterior pole of the eye and the optic nerve, thus achieving the maximum concentration of the drug. Treatment is carried out for 10-14 days.

Selective laser trabeculoplasty- a soft laser effect on the area of ​​outflow of intraocular fluid, is not accompanied by visible tissue damage, and better helps in the early stages of pigmentary glaucoma. Subsequently, intraocular pressure monitoring is required for several days.

Iridoplasty- a targeted effect on the root of the iris, aimed at releasing the iris tissue from involvement in adhesions for better outflow of intraocular fluid.

Laser iridectomy- used for glaucoma with a narrow angle of the anterior chamber of the eye, occurs painlessly within a few minutes.

Laser trabeculoplasty- impact on the outflow zone of intraocular fluid with a mild coagulating effect, aimed at opening the trabecular meshwork. It is used for open-angle glaucoma and is performed on an outpatient basis within a few minutes.

Observation and management of patients with glaucoma and suspected glaucoma- the main parameters of the eye change over time, but the patient cannot evaluate them independently, since the increased intraocular pressure is not felt by the person, and the missing areas of the visual field remain invisible.

For these reasons, it is necessary to periodically monitor the condition of the patient’s eye, optimally monitoring 3-4 times a year.

Surgical treatment of glaucoma

Concerning surgical treatment, then the operation of non-penetrating deep sclerectomy (NGSE) allows you to restore the natural balance of fluid in the eye in open-angle forms of glaucoma.

Penetrating operations are used for advanced stages of glaucoma, both with and without drainage.

For closed-angle forms, both traditional operations and the method of removing the transparent lens with implantation of an intraocular lens are used (if the size of the lens does not correspond to the size of the eye).

Advantages of glaucoma treatment at MEDSI

  • Highly qualified ophthalmologists, ophthalmic surgeons
  • Operations of any complexity in a hospital, full treatment of diseases requiring hospitalization. Fast rehabilitation
  • All types of treatment of the disease (conservative therapy, laser and surgical treatment)
  • Treatment and diagnostics at MEDSI are carried out in accordance with international protocols, using modern high-tech techniques

Decreased visual acuity in elderly patients is a huge problem in modern medicine. As a rule, when visiting an ophthalmologist, one in three patients over 65 years of age is diagnosed with visual impairment, one of the causes of which may be glaucoma. The disease potentially leads to blindness. According to the World Health Organization, one adult in the world goes blind every minute from glaucoma, and one child goes blind every 10 minutes.

Signs of glaucoma

The first symptoms of glaucoma:

    deterioration of twilight and night vision;

    rainbow circles around light sources;

    feeling of heaviness, fullness in the eye;

    feeling of a false tear;

    changing distance and near glasses more often than once every 3 years.

Glaucoma is characterized by a constant or periodic increase in intraocular pressure with the subsequent development of typical visual field defects, decreased vision and atrophy of the optic nerve.

Types of Glaucoma

There are three main types of glaucoma: congenital, primary and secondary.

The first type of glaucoma is caused by congenital defects in the development of the anterior chamber angle or drainage system of the eye. If the disease appears immediately or soon after birth (before 3 years), it is called infantile glaucoma. However, with mild developmental defects, ocular hypertension may not develop for a long time. In such cases, the disease manifests itself later, in childhood or adolescence (juvenile glaucoma).

In primary glaucoma, degenerative processes in some eye tissues cause increased intraocular pressure. Secondary glaucoma is a consequence of other diseases and is also manifested by increased ophthalmotonus.

Primary glaucomas are divided into open-angle and closed-angle.

The concept of “primary open-angle glaucoma” unites a large group of diseases that are characterized by all of the above signs of glaucoma. During examination, the angle of the anterior chamber of the eye is open.

In primary angle-closure glaucoma, the cause of increased intraocular pressure is an obstruction to the outflow of aqueous humor due to partial or complete blockage of the anterior chamber angle by the root of the iris or as a result of pupillary block. The etiology of primary angle-closure glaucoma is associated with a large number of factors:

    individual anatomical features;

    the intensity and nature of age-related changes in various structures of the eye, especially in its drainage system;

    individual characteristics of metabolic processes;

    the state of the nervous and endocrine systems of the body.

An acute attack of angle-closure glaucoma is clinically manifested by a sharp appearance of pain in the eye, eyebrow and corresponding half of the head, and decreased vision (sometimes significant). Watery eyes, photophobia, and blepharospasm may also occur. An acute attack of angle-closure glaucoma requires immediate conservative and, if necessary, surgical treatment.

The process of glaucoma development is conventionally divided into 4 stages. In the diagnosis, stages are designated by Roman numerals from I – initial to IV – terminal. In this case, the state of the visual field and the optic nerve head are taken into account.

DIAGNOSIS OF GLAUCOMA

Early diagnosis is extremely important in treating the disease. The standard examination scheme for a patient with suspected glaucoma includes:

    determination of visual acuity (visometry);

    determination of the level of intraocular pressure (tonometry);

    examination of the anterior segment of the eye using a slit lamp (biomicroscopy);

    determination of the boundaries of the field of view (perimetry);

    examination of the retina and optic nerve head (ophthalmoscopy);

    fluorescein angiography of the fundus,

If necessary, an ultrasound B-scan can be performed.

TREATMENT OF GLAUCOMA AT THE EMC OPHTHALMOLOGICAL CLINIC

The level of intraocular pressure can be reduced by medication, laser and surgery. In the vast majority of cases, treatment of patients with glaucoma begins with local antihypertensive therapy (instillation of drops).

Goals of glaucoma treatment:

    preservation of vision;

    achieving a therapeutic effect with a minimum amount of drugs with a minimum of side effects;

    maintaining a good quality of life for patients.

If the effect of antihypertensive drug therapy is insufficient, laser treatment of glaucoma is performed. The EMC clinic has the most modern YAG laser from NIDEK. Features of operations on such equipment:

    low invasiveness of the procedure;

    absence of serious intra- and postoperative complications;

    possibility of treatment on an outpatient basis.

Surgical treatment of glaucoma is carried out in the absence of a hypotensive effect from conservative therapy (achievement of target pressure) or ineffectiveness of laser treatment. All antiglaucomatous operations are carried out using modern disposable consumables from Alcon (USA). If necessary, Ahmed or Ex-press drainage is installed. All doctors at the EMC Ophthalmology Clinic undergo regular training to use the most modern equipment.

The most effective surgical intervention for open-angle glaucoma is non-penetrating deep sclerectomy. This surgical treatment of glaucoma is carried out on an outpatient basis, under local anesthesia, for no more than 10-15 minutes.

In order for the postoperative period to pass without complications and in the shortest possible time, you should:

    do not rub or press on the operated eye;

    after a shower, instill disinfectant drops for the first 2 weeks;

    do not expose the operated eye to sudden temperature changes: for the first month you must refrain from visiting the sauna, bathhouse, steam room;

    for a month after the operation, refrain from performing physical work associated with heavy lifting and prolonged bending of the body;

Glaucoma is a disease that requires a thorough examination and immediate prescription of the necessary treatment. At EMC you can consult with an experienced ophthalmologist and undergo the necessary examinations using the most advanced equipment. After all the procedures are completed, the doctor will develop an individual treatment plan for the disease.

ADVANTAGES OF USING EMC

    The EMC Ophthalmology Clinic has created all the conditions for a quick, comprehensive diagnosis of glaucoma.

    We treat glaucoma using the most effective methods available today, which are safe even for older people.

    We perform operations of any complexity, even in late stages of disease.

    We provide 24-hour emergency ophthalmological care to adults and children.

    Our ophthalmologists are professionals with extensive experience in leading clinics around the world.

Diagnosis glaucoma diagnosed by an ophthalmologist after changes in the optic nerve, known as “escavation” of the optic nerve, have been detected or suspected. The diagnosis of GLAUCOMA can be made with both high and low intraocular pressure (IOP).

Normal IOP is considered to be between 12.0 and 22.0 mmHg, and, as a rule, increased IOP is the main cause of the disease GLAUCOMA. But despite this, many people with elevated IOP do not suffer from GLAUCOMA, while the diagnosis of GLAUCOMA can be made to people with normal intraocular pressure, this diagnosis is called normal pressure GLAUCOMA.

Therefore, in making this diagnosis, it is extremely important to conduct a complex of diagnostic studies, which is not limited to just measuring Intraocular Pressure.

  • Measure the depth and angle of the anterior chamber of the eye (OST of the anterior segment of the eye).
  • Measure and analyze changes in the optic nerve (OCT of the posterior segment of the eye).
  • Measure and analyze visual fields.
  • Measure IOP using contact and non-contact methods.

If there are changes in the optic nerve, this is confirmed by a change in the visual fields, which is not noted by the patient himself for a long time and leads to the progression of the disease and irreversible loss of vision. Only preventive dynamic observation with a competent examination allows timely identification of this formidable disease, which leads to irreversible blindness without proper, timely and adequate treatment.

Glaucoma is a chronic eye disease characterized by a constant or periodic increase in intraocular pressure (IOP) with the development of trophic disorders in the outflow pathways of intraocular fluid (IOG, aqueous humor), in the retina and in the optic nerve, causing the appearance of typical defects in the visual field and the development of marginal excavation (deepening, pushing) of the optic nerve head.

The main goal of glaucoma treatment is to normalize eye pressure.

There are three treatment options: conservative, laser correction and surgery. Your doctor will decide which route is right for you. The choice of treatment method depends on the type and stage of the disease. And The age of the patient plays an important role.

Conservative methods of treating glaucoma- this is the use of various drops, intramuscular, intravenous, and parabulbar injections (under the eyeball). You should know that all medications for the treatment of glaucoma are strictly not recommended for self-administration. Both dosages and duration of use should be selected by the doctor strictly individually, depending on the characteristics of the patient. Sometimes it is necessary to use several methods to maintain stabilization of intraocular pressure.

Three goals of drug treatment of glaucoma:

  • reduction of intraocular pressure (ophthalmic hypotensive therapy);
  • improving blood supply to the inner membranes of the eye and the intraocular part of the optic nerve;
  • normalization of metabolic processes (metabolism) in the tissues of the eye in order to influence the degenerative processes characteristic of glaucoma.

As we have already said, the most important point in the treatment of glaucoma is the normalization of the level of intraocular pressure, and techniques aimed at improving blood circulation and influencing metabolic processes in the eye are only auxiliary. The right lifestyle is of great importance: adherence to work and life schedule.

Laser treatment

Laser radiation has been widely used in the treatment of glaucoma for more than 40 years.

It has a number of advantages, including:

  • restoration of the outflow of intraocular fluid through natural pathways;
  • no general anesthesia is required (instillation of a local anesthetic is sufficient);
  • the operation can be performed on an outpatient basis;
  • minimum rehabilitation period;
  • there are no complications of traditional glaucoma surgery;
  • low cost.

The goal of laser surgery in the treatment of glaucoma is to eliminate intraocular blocks that occur in the path of the outflow of intraocular fluid in the eye.

The action of lasers is based either on the application of a local burn to the trabecular area, followed by atrophy and scarring of its tissue (coagulator lasers), or on a microexplosion, which is accompanied by tissue rupture and a shock wave (destructor lasers).

The most widespread are laser iridotomy (iridectomy) and laser trabeculoplasty.

Please remember that vision loss due to glaucoma cannot be restored. Therefore, the best way out is to treat glaucoma in a timely manner and regularly monitor intraocular pressure.

Surgery

The main task of surgical operations- reduction and normalization of increased intraocular pressure, creation of conditions for the most favorable microcirculation in the optic nerve, removal of the phenomena and consequences of its hypoxia, improvement of nutrition and tissue metabolism in it. Any antiglaucomatous operation can be considered successful if in the long term after the operation (6-12 months) the achieved level of intraocular pressure is firmly maintained at the lower limit of normal.

Over the century and a half history of glaucoma surgery, a huge number of antiglaucomatous operations have been proposed, and new techniques and their modifications are constantly appearing.

The issue of surgical treatment of open-angle glaucoma is decided individually, taking into account the characteristics of the course of the disease.

For open-angle glaucoma apply non-penetrating deep sclerectomy (NGSE)- an effective operation that allows you to restore the natural balance of fluid in the eye.

The operation is performed in the early stages of the disease, when there are no organic changes in the drainage system. The operation is indicated for decompensation of intraocular pressure on drops or the inability to comply with the correct regimen for using antiglaucomatous drugs. The effect of the operation decreases gradually over several years, at varying rates, due to tissue scarring. In this regard, NGSE is combined with the use of collagen or hydrogel drainages, which prevent tissue scarring and reduce the effect of surgery in the future. The efficiency of NGSE is also increased by the use of excimer, YAG and argon lasers. Laser surgery is performed without opening the eyeball.

Advantages of NGSE:

  • minor trauma to eye tissue;
  • the operation is performed on an outpatient basis;
  • possibility of rapid visual rehabilitation (1-2 days);
  • minor restrictions in the postoperative period (the patient can start working in a few days);
  • absence of serious surgical and postoperative complications (such as choroidal detachment, intraocular hemorrhages, etc.);
  • this operation does not provoke the development of cataracts;
  • during the operation there is no deep disruption of the natural mechanisms of the outflow of intraocular fluid;
  • the patient does not require long-term instillation of drops and long bed rest.

Patients with advanced and terminal open-angle glaucoma (stage 3-4), advanced, advanced and terminal angle-closure glaucoma (stage 2-3) with an anatomical block of the anterior chamber angle (for example, angle-closure glaucoma with a “creeping” iris, neovascular glaucoma, iridocorneal endothelial syndrome) traumatic, hemorrhagic glaucoma can be recommended fistulizing operations. During the operation, a tubular drainage is placed in the anterior chamber, which filters moisture from the anterior chamber, bypassing the sclerotic and incompetent drainage system. The operation allows you to effectively, quickly and permanently reduce intraocular pressure in eyes with residual visual functions.

When glaucoma and cataracts are combined in one eye, especially with swelling cataracts, it makes sense to perform combined two-stage operations to remove the cloudy lens (phacoemulsification of cataracts) and normalize intraocular pressure using shunting.

Watch the video:

The advisability of combined treatment is decided by the surgeon in each individual case.

Requirements for glaucoma surgery are changing towards minimally invasive surgery.

Since 2016, after lengthy trials in the EU and the USA, 2 new minimally invasive antiglaucomatous bypass operations have finally been approved for use.

1. Xen Gel Stent from the American company Allergan

The main indication for implantation is primary open-angle glaucoma, the most common type of glaucoma (about 74% of glaucoma patients are diagnosed with Primary Open-Angle Glaucoma (POAG), which is the second cause of blindness in the world after cataracts). Xen Gel Stent developed using new technology. It is made from soft gelatin derived from hydrolyzed collagen. AquaSys gelatin is absolutely biocompatible with eye tissues and does not cause inflammatory reactions. The stent is 6 mm long and no thicker than a human hair.

The stent is implanted into the subconjunctival space by passing through the angle of the anterior chamber, where it is inserted through a 1.5 mm corneal incision using an injector in which it is pre-positioned in a dehydrated state. (Figure 1, Figure 2)

The stent is implanted in such a way that one part of it is in the anterior chamber, and the other lies in the subconjunctival space. Next, the corneal paracentesis is self-sealing. Thus, the entire operation takes place without a single seam. (Figure 3)

As soon as it comes into contact with the intraocular fluid, it becomes elastic, soft and completely adapts to the anatomical profile of the eye tissue. This is very important to prevent the risk of complications (corneal erosion, endothelial damage, migration of inflammatory cells) that occur when implanting stents made of rigid synthetic materials.

After implantation, it produces a mild diffuse outflow of intraocular fluid and a persistent decrease in intraocular pressure. (Figure 4)

2. (Trancend Medical/Alcon) - another step in the evolution of microinvasive glaucoma surgery.

Its effectiveness is recognized in Europe and the USA. It is intended to reduce intraocular pressure in patients with primary open-angle glaucoma.

The stent consists of a fenestrated polyamide tube 6.0 mm long, biocompatible with eye tissues, with a lumen diameter of 330 µm.

Before surgery, the patient's pupil is constricted with medication, which improves visualization of the anterior chamber angle under gonioscopy. Next, a 2.0 mm corneal paracentesis is formed, through which the CyPass Micro-Stent is inserted into the anterior chamber using a special injector towards the root of the iris, focusing on the scleral spur (or posterior Schwalbe ring). The stent is then advanced into the supraciliary space. Thus, one end is located between the sclera and the ciliary body, and the other end is placed in the angle of the anterior chamber, which ensures a continuous flow of intraocular fluid into the suprachoroidal space. This outflow pathway is as physiological as possible.

ADVANTAGES of microstents (Xen Gel Stent and CyPass Micro-Stent) are:

  • Minimally invasive, sutureless surgery, with minimal surgical trauma,
  • Formation of physiological pathways for the outflow of intraocular fluid,
  • Reducing possible complications
  • Short rehabilitation period

The most common cause of glaucoma is increased intraocular pressure, which occurs as a result of impaired outflow of intraocular fluid. Glaucoma usually affects older people, but can also occur at a young age. If this pathology is ignored, irreversible damage to the optic nerve will occur, which will lead to deterioration of vision, and then to its complete loss.

Are you looking for a clinic for the treatment of glaucoma in Moscow? At the Doctor Visus clinic, experienced ophthalmologists successfully treat glaucoma at different stages. We carry out diagnostics using modern equipment (Perikom perimeter, Ocular Response Analyzer - ORA, Reichert Inc., USA, etc.), and then select the optimal treatment methods.

Advantages of glaucoma treatment in our clinic

Experienced ophthalmologists

The specialists of the Doctor Visus clinic are qualified doctors of the first and highest categories, candidates and doctors of science. Our ophthalmologists have undergone training in the best specialized clinics and use only progressive, effective methods in their practice. Positive reviews about the treatment of glaucoma from grateful patients are the best evidence of the professionalism of our clinic’s doctors.

Reliable diagnostics

Accurate diagnosis is the key to successful treatment. In our center, glaucoma treatment is prescribed only after a comprehensive examination using the latest equipment. The Reichert AT 55 pneumotonometer measures intraocular pressure. The field of view is examined using the Perikom perimeter. The Ocular Response Analyzer will help you determine the biomechanical properties of the eye with high accuracy.

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