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Thursday, 28 November 2013

Glaucoma Treatments In conventional medicine perspective

Glaucoma is a medical condition of an eye disease as result of the damage of the nerve of eye’s optic over time. If left untreated, it can lead to permanently vision impair and blindness.
VI. Treatments
A. In conventional medicine perspective
A.1. Eye-drops
1. Prostaglandins used to treat patients with open-angle glaucoma.
In the study to evaluate the safety and efficacy of tafluprost, a fluoroprostaglandin receptor analog, for reduction of intraocular pressure in open angle glaucoma and ocular hypertension, indicated that Since can not be cure, the aim of the treatment is to lower pressure in your eye (intraocular pressure) or improve drainage of fluid or lower the amount of fluid produced in your eye, depending to the types of the disease. Since its introduction in 2008, initial studies have demonstrated that preserved and preservative-free tafluprost formulations have proven efficacy and safety in the treatment of glaucoma and ocular hypertension. Larger studies with longer follow-up are needed to assess long-term safety, efficacy, and tolerability compared with other prostaglandin analogs used for treating glaucoma(56).
2. Beta blockers used to reduce the production of fluid and pressure in your eye.
According to the study by Royal Victorian Eye and Ear Hospital, the most serious side effects of beta-blockers are the exacerbation of chronic obstructive airways disease with nonselective agents and the precipitation of bronchospasm in some patients. Betaxolol seems relatively free of adverse respiratory effects, although this may be dose-related and extreme caution should still be exercised in patients with any history of respiratory illness. Because of the lower risk of precipitating side effects, betaxolol is probably the beta-blocker of first choice for use in glaucoma; timolol or levobunolol are reserved for patients who do not respond satisfactorily to betaxolol and are quite free of respiratory disease(57).
3. Alpha-adrenergic agonists used to reduce the production of aqueous humor and increase outflow of the fluid in your eye.
In the study to compare the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% in preserving visual function in low-pressure glaucoma, showed that low-pressure glaucoma patients treated with brimonidine 0.2% who do not develop ocular allergy are less likely to have field progression than patients treated with timolol 0.5%(58).
4. Miotic agents used to increase the outflow of fluid in your eye.
Pilocarpine, a parasympathomimetic drug used in the treatment of glaucoma, produces a variety of ocular and systemic adverse reactions, such as miosis, accommodative spasm, frontal headaches, twitching lids, conjunctival injection, cataractous changes, allergic reactions, iris cysts, retinal detachment, increased permeability of the blood-aqueous barrier, anterior chamber narrowing, and the potential for inducing an acute angle-closure attack(59).
A.2. Oral medications if eye-drop fails
Oral medication such as the local carbonic anhydrase inhibitors (CAH) dorzolamide and brinzolamide have become well established in the drug therapy of glaucoma. They lower intraocular pressure (IOP) by blocking specifically carbonic anhydrase in the ciliary epithelium and thereby the secretion of aqueous humor, according to the study by Institut für Anatomie – LS II, Universität Erlangen-Nürnberg(60). With side effects not limit to frequent urination, a tingling sensation in the fingers and toes, depression, stomach upset, etc.
A.3. Gene therapy
Retinal degenerations encompass a large number of diseases in which the retina and associated retinal pigment epithelial (RPE) cells progressively degenerate leading to severe visual disorders or blindness.
Retinal degenerations can be divided into two groups(environmental and genetic influences, and the second group belong glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR)). According to the study by Universitätsaugenklinik / IZKF Aachen, in the last few years inhibitors of vascularization, especially antibodies against vascular endothelial cell growth factors (VEGF), have been used to prevent the neovascularization that accompanies AMD and DR resulting in the amelioration of vision in a significant number of patients. In animal models it has been shown that transfection (the process of deliberately introducing nucleic acids into cells) of RPE cells with the gene for PEDF and other growth factors can prevent or slow degeneration. A limited number of studies in humans have also shown that transfection of RPE cells in vivo with the gene for PEDF is effective in preventing degeneration and restore vision. Most of these studies have used virally mediated gene delivery with all its accompanying side effects and have not been widely used(61).
A.4. Surgery
Surgery in some cases may be necessary, if patients do not respond to the neither treatments of eye-drops and oral medication.
1. Laser surgery
The angle closure glaucomas are defined by iridotrabecular contact, trabecular dysfunction, and elevated intraocular pressure (IOP). According to the study by Manhattan Eye, Ear, and Throat Hospital, laser iridotomy successfully eliminates the relative pupillary block component of the angle closure process, regardless of whether the underlying angle closure is related primarily to pupillary block or another mechanism(62).
2. Filtering surgery
The aims of the treatment is to help the eye drain liquid more effectively. According to the study by Capital University of Medical Science and Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, after marked reduction of high IOP, some eyes of young adult patients with glaucoma can show a horizontal shrinkage of the optic nerve head, in addition to a partial restoration of the neuroretinal rim and a flattening of the optic cup. In addition, beta zone of parapapillary atrophy can decrease or increase, complementarily to changes in the horizontal disc diameter(63).
3. Drainage implants
The treatment is often used in patients who are poor candidates for glaucoma filtration surgery. In the study to review and to critically compare the various glaucoma drainage implants in popular use, showed that there are several glaucoma drainage implants that are currently available, and all have been shown to be safe and effective in reducing intraocular pressure. Greater pressure reduction may be achieved with implants with larger end plates, and valved implants appear to reduce the risk of postoperative hypotony(64).
4. In case of Acute angle-closure glaucoma
According to the study by Hôpital Saint Joseph, acute angle closure attack is more symptomatic, with a red painful eye and elevated intraocular pressure. In both cases, iridocorneal angle closure is due to an increase in the thickness of the natural lens, which with age has a tendency to close a narrow angle. The rational approach to treating these situations is lens extraction. With today’s improved lens extraction techniques, this surgical treatment should be proposed more frequently(65).
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