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THE ORIGIN, DIAGNOSIS AND MODERN CLINICAL DIAGNOSTICS OF ANGLE-
CLOSURE GLAUCOMA
¹Muxtorov Shohboz
²Ochilova Shirin Rahmiddinovna
³Saydullayev Dilshod Mirzohid o’g’li
¹'²'³Samarkand State Medical University, 1st year clinical residents of the Department of
Ophthalmology.
https://doi.org/10.5281/zenodo.14886255
Relevance of the study:
According to the International Diabetes Federation (IDF), in
2019, the number of people with diabetes mellitus (DM) exceeded 463 million people [1]. In
Russia, according to the State Register of Patients with Diabetes mellitus for 2018, their number
was 4.58 million, which is 3.1% of the country's population. These data show only the number of
patients registered in the dispensary, but according to the All-Russian Epidemiological Study on
Type 2 Diabetes NATION, there is a significantly larger group of people who are unaware of their
disease [2]. The number of undiagnosed cases reaches about 46%, which increases the total
number of patients with diabetes in Russia to 8.5-9 million people, which is already about 6% of
the population [3]. Patients in this category do not receive the necessary therapy and are not warned
about the complications that diabetes can cause. These include patients with ocular pathology in
the anterior segment of the eye - secondary neovascular glaucoma (NG) complicated by cataracts,
corneal ulcers, etc., and in the posterior segment - hemophthalmos and retinal detachment caused
by the unfavorable development of diabetic retinopathy (DR) [4].
Materials
: DR is characterized by damage to the retinal vessels and is one of the severe
complications of diabetes. The medical and social significance of this problem is very high, since
the patient has a high risk of disability. Thus, according to the conducted study "Diabetic
Retinopathy Barometer", 83% of the surveyed diabetic patients know about such a terrible
complication as vision loss. Moreover, every 7th patient attributes their visual impairment to age-
related changes, the cause of which is the underlying disease [5]. In Russia, as of 01.01.2019, DR
was recorded in more than 850 thousand patients [6].
Research methods:
In 1963, DI Weiss and colleagues first proposed the term "neovascular
glaucoma" (NG). G. Coats first described newly formed vessels in the iris in a patient with central
retinal vein occlusion. With the introduction of gonioscopy into clinical practice - examination of
the angle of the anterior chamber of the eye - it became possible to see newly formed vessels in
the projection of the trabecular zone, and the increase in intraocular pressure (IOP) was explained
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by mechanical closure of the iridocorneal angle [7]. Due to the high degree of disability, many
authors consider NG to be an important and urgent problem of modern ophthalmology [8].
Results
: A clinical case of angle-closure glaucoma due to occlusion of the anterior chamber
angle by a ciliary div cyst is presented. Patient A., 42 years old, complained of temporary blurred
vision in the right eye and worsening of night vision. At the initial ophthalmological examination,
the best-corrected visual acuity of both eyes was 1.0, intraocular pressure according to
pneumotonometry: OD - 21 mm Hg. Art., OS - 14.8 mm Hg. Art. During biomicroscopy, no
changes were detected in the anterior segment of the eyeball. Taking into account the asymmetry
of IOP data, the patient underwent the following studies: static perimetry, optical coherence
tomography (OCT), flowmetry with calculation of intraocular pressure (TIOP).
According to the data of OCT and static perimetry, no pathological abnormalities were
detected. In the left eye, flowmetry parameters were within normal limits, but in the right eye, a
significant decrease in volumetric ocular blood flow and an increase in IOP were detected. When
calculating TVGD, we found asymmetry of the values. In the left eye, TGVD coincided with IOP,
and in the right eye, IOP values exceeded the TGVD value. The lack of correlation between
morphofunctional parameters and flowmetry data, an uncomplicated hereditary history of
glaucoma, and a discrepancy between flowmetry parameters and age may indicate the
development of glaucoma, so the patient was referred to UBM. The echographic picture of the
anterior segment of the right eye was characterized by a decrease in the depth of the anterior
chamber, partial forward displacement of the peripheral part of the iris, a slight narrowing of the
angle of the anterior chamber, and uneven posterior chamber. A large, thin-walled, anechoic mass
with clear contours and dimensions, 4.3 mm high and 4.8 mm long, was detected in the area of the
process of the ciliary div along the 3 o'clock meridian. The iris root was identified with its medial
attachment to the ciliary div. Accordingly, the diagnosis was made: OD - ciliary div cyst, the
patient was referred for consultation for possible laser surgery
Discussion
: Currently, the generally accepted classification of DR is the WHO
classification proposed by E. Kohner and M. Porta in 1991, in which secondary NH is not a
separate stage of proliferative DR, but a complication of the advanced process (with narrowing of
the retina). These severe complications often lead to blindness.
Conclusion
: Patients with a combination of NG and diabetes pose great difficulties for
doctors, as they have to simultaneously struggle with two serious diseases - diabetes and glaucoma.
The availability of modern, high-tech diagnostic and treatment equipment significantly expands
the possibilities of treating these patients, but does not eliminate the need to search for new
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treatment methods. Close communication between specialists of various profiles
(ophthalmologists, endocrinologists, etc.) in the treatment of this pathology can achieve significant
success in solving this problem. The issues of pathogenesis, classification, diagnosis, treatment
and prevention of secondary NH in patients with diabetes mellitus are relevant and require further
research to improve the social adaptation and integration of these patients into modern society.
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