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OPEN-ANGLE GLAUCOMA: ORIGINS, DIAGNOSIS, AND MODERN CLINICAL
DIAGNOSTICS
¹Shodmanov Abbos
²Sattorov Bobur Urol o'g'li
¹'²Samarkand State Medical University, 1st year clinical residents of the Department of
Ophthalmology.
https://doi.org/10.5281/zenodo.14886216
Relevance of the problem:
The cribriform plate of the sclera consists of several parts, the
last of which is the thickest and most rigid in the back. The holes in each individual plate form
channels through which bundles of nerve fibers pass. When tilted back under the influence of
increased IOP, the displacement of the layers of the cribriform plate relative to each other leads to
damage (compression) of the network of vessels passing through the nerve fibers and tubules.
Peripheral nerve fibers are more affected, since the displacement of the plates relative to
each other is more pronounced in the periphery. Thus, when IOP increases in the posterior part of
the eye, the nerve fibers suffer from direct mechanical damage and impaired blood
microcirculation in this area. A leading factor in the pathogenesis of open-angle glaucoma is partial
blockage of the scleral sinus by the trabeculae displaced under the influence of increased IOP.
Research methods and materials:
Metabolic mechanisms involved in the pathogenesis
of glaucoma can be divided into primary and secondary. Primary mechanisms precede the increase
in IOP and continue to function after the normalization of ophthalmotonus. Secondary metabolic
disorders occur as a result of the direct mechanical effect of high IOP on the hemodynamics of the
eye. The causes of metabolic shifts include circulatory disorders leading to ischemia and hypoxia.
Metabolic disorders leading to the onset and development of glaucoma also include
pseudoexfoliative dystrophy, lipid peroxidation, and disorders of glycosaminoglycan metabolism
in the anterior segment of the eye. Age-related decrease in the activity of the ciliary muscle, which
is involved in the nutrition of the avascular trabecular meshwork, negatively affects the state and
metabolism of the drainage system of the eye. The existence of two main mechanisms of the
glaucomatous process has determined two main approaches to its drug treatment. One of them is
aimed at reducing IOP, while the other is aimed at correcting hemocirculation and metabolic
changes.
Conclusions
: Since the level of IOP that is safe for the optic nerve in patients with
glaucoma is often reduced, its optimal value should be considered to be 3-5 mm Hg. Art. below
the upper limit of the norm.
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Therefore, one of the principles of glaucoma treatment should be a dosed and controlled
effect on the hydrodynamics of the eye. It is recommended to adhere to another principle of
glaucoma treatment. There are various mechanisms that regulate the circulation of aqueous humor,
blood microcirculation and metabolic processes in the eye. The therapeutic effect should not overly
depress them for a long time. Antihypertensive drugs include miotics (pilocarpine), beta- blockers
(timolol maleate, betaxolol), α- adrenergic agonists (clonidine, apraclonidine, brimonidine),
adrenaline drugs (epinephrine bitartrate, dipivalyl epinephrine), prostaglandin-anhydrin inhibitors
(lamid hydrochloride). The main advantage of miotics is the pathogenetic substantiation of their
effect on intraocular pressure. By narrowing the pupil and pulling the root of the iris away from
the angle of the anterior chamber, they improve the access of aqueous humor to the drainage
system of the eye. At the same time, the trabecular diaphragm is stretched, its permeability
increases, and Schlemm's canal expands. Currently, the first choice drugs are beta-blockers. The
latter are divided into non-selective, blocking both types of β-adrenergic receptors, and selective,
primarily β-2-adrenergic receptors. Of the drugs of the first group, timolol maleate is most often
used, and betaxolol from the second group. Of other agents that reduce the production of aqueous
humor, alpha-adrenergic agonists have become widely used. This group includes clonidine,
apraclonidine, and brimonidine. In terms of the severity of their hypotensive effect, these drugs
are similar to timolol. Significant progress has been made in the creation of drugs that inhibit
carbonic anhydrase when applied topically. In terms of the severity of its effect on the secretion of
aqueous humor and IOP, dorzolamide is comparable to β-blockers and acetazolamide. Among
ocular hypotensive drugs, adrenaline occupies a special place. Adrenaline reduces the production
of aqueous humor for a short time, but mainly improves its outflow. Currently, the most widely
used solution is 0.1% epinephrine dipivalate, which is 17 times more bioavailable than adrenaline.
This made it possible to reduce the concentration of the active substance in eye drops from
1.2 to 0.1% and, accordingly, reduce the frequency and severity of side effects.
Discussion
: Among the recent advances in ophthalmopharmaceuticals, it is worth noting
the introduction of prostaglandin F2α derivatives latanoprost and unoprostone. These drugs, which
are unique in their mechanism of action, activate the uveoscleral pathway of fluid outflow from
the eye, have virtually no side effects and have a high hypotensive effect. Currently, the first-
choice drugs are β-blockers, but even with their complete normalization of IOP, instillation of one
of the cholinomimetics in a minimum concentration 1-2 times a day should be added.
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This improves the outflow of aqueous humor from the eye without causing a permanent
and complete spasm of the ciliary muscle. To reduce the negative effects of the drug phenomenon,
it is recommended to change the drug every 2-3 months.
Conclusion
: The main type of intervention for open-angle glaucoma is laser
trabeculoplasty, which is a traction method aimed at improving the outflow of intraocular fluid
through natural drainage pathways. Laser cauterization of the structures of the anterior chamber
angle of the eye leads to tissue retraction, stretching of the trabecular apparatus, opening of the
scleral sinus, and improved outflow of intraocular fluid. In addition, hydrodynamic activation of
the extraction operation (HAO) is currently used. Unlike trabeculoplasty, it is performed using a
pulsed laser with a piercing effect - a YAG laser. GAO leads to an expansion of the intertrabecular
spaces, removes pigment and exfoliation from the thickness of the trabeculum, and also partially
thins it. The effect of the operation is also manifested in cases where repeated argon laser
interventions did not have a hypotensive effect. Laser interventions are also used to combat
postoperative complications and correct surgical defects. These include goniospasm in functional
blockade of the anterior chamber angle, reperforation in non-penetrating coloboma of the iris,
plastic surgery of the filtration site in excessive external filtration, and hyphema coagulation in the
development of postoperative hemorrhage into the anterior chamber of the eye.
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