Material and methods
In the Department of Diabetic Retinopathy and Ophthalmic Surgery of the Federal State Budgetary Institution Scientific Research Center of the Ministry of Health of Russia (Moscow), for the period from June 2012 to January 2014 inclusive, 50 patients (51 eyes, 21 men and 29 women) with symptoms of secondary uncompensated NG in combination with diabetes were observed . The average age of the patients was 63.4±3.7 years. The average duration of diabetes was 14.0±3.6 years, the average level of glycated hemoglobin was 8.9±1.8 mmol/l. All patients underwent routine endocrinological (monitoring of blood sugar, glycated hemoglobin, triglyceride levels, cholesterol) and ophthalmological (visometry, ophthalmoscopy, gonioscopy, non-contact tonometry, tonography, perimetry) examination. If necessary, studies were carried out aimed at identifying and clarifying complications of diabetes and concomitant somatic pathology.
When visiting a doctor, every 5th patient was without any antihypertensive regimen; for the rest, it was ineffective, as evidenced by the average IOP level, which, according to non-contact tonometry, was 46.8 ± 2.8 mm Hg. and when measured using Maklakov’s method - 48.7±2.6 mmHg. All patients had their antihypertensive regimen changed during the period of preparation for surgery, and if there was no effect, drainage surgery was performed. For this purpose, the previous treatment was canceled and the combined drug Ganfort was prescribed, one drop into the conjunctival sac once in the morning. The patients were conditionally divided into 2 groups: the 1st group included patients who “responded” to Ganfort therapy (37 eyes, 72.5%), who did not require surgical intervention, and the 2nd group included patients (14 eyes, 27. 5%) whose IOP decreased but did not reach the target value. They underwent drainage antiglaucoma surgery.
Ganfort eye drops: instructions for use
The effectiveness of Ganfort is explained by its unique composition, which includes two active components at once. The first of them - bimatoprost - is an analogue of prostaglandins, the essence of its effect is to activate the outflow of intraocular fluid. The second compound is timolol, a beta-blocker that reduces the formation of the same moisture.
Anatomy of an eye with glaucoma
Due to its double effect, the drug actively reduces blood pressure. Indications for use are:
- open-angle glaucoma;
- intraocular hypertension.
Bimatoprost has a side effect that is often noted by patients - increased eyelash growth. The effect is achieved by increasing life expectancy and the appearance of new hairs. Today this compound has become widespread in cosmetology.
Such diagnoses require constant monitoring by an ophthalmologist, and it is the doctor who must decide on the use of drops. Ganfort is often prescribed when a beta-blocker or prostaglandin analog alone does not give the desired result.
The drug should not be taken for cosmetic purposes
It is important to prevent the development of complications due to keratitis - treatment of inflammation of the cornea of the eye.
Results and discussion
All patients (51 eyes, 100%) experienced a decrease in IOP after starting to use the drug. The IOP level according to non-contact tonometry in patients of group 1 who did not require surgical treatment decreased within 2 weeks by 2.5 times compared to the baseline and amounted to 18.7 ± 1.7 mm Hg. (Table 1)
.
In patients with pain when visiting a doctor (40 patients, 40 eyes), it was relieved within 2 weeks of taking the drug, including in patients who later required surgical intervention.
Analysis of the number of “adverse” events when using Ganfort showed that the data we obtained did not differ significantly from those in the study by A. Hommer [8] (Table 2)
.
It should be taken into account that A. Hommer studied these phenomena in patients without diabetes with “usual” primary open-angle glaucoma, and not with secondary NG and diabetes.
In this regard, hyperemia of the conjunctiva, detected during biomicroscopy in some patients (Fig. 1)
Figure 1. Fig. 1. Local hyperemia of the conjunctiva during instillation of Ganfort. , in our opinion, cannot be attributed to complications of drug therapy. The effect of compensating the level of IOP in such severe patients clearly exceeds the slight hyperemia of the conjunctiva, which is often detected only during biomicroscopy.
In group 2 (14 patients, 14 eyes), the IOP level also decreased significantly (Table 3)
, but did not reach the target value. Due to a further decrease in visual functions and unfavorable development of the process, a decision was made on the need for surgical intervention. They underwent glaucoma drainage surgery using Ahmed valves (10 cases) and Molteno valves (4 cases). After using drainage surgery, stable compensation of IOP was achieved in all cases, which was also observed in the long-term postoperative period.
The lack of the desired effect in achieving the target pressure in the 2nd group of patients cannot be considered as a failure in the use of the drug Ganfort in patients with uncompensated neovascular glaucoma. A decrease in IOP by almost 30% compared to the baseline (from 46.8 to 32.8 mm Hg, respectively) led to a decrease in the number of hemorrhagic complications (hyphema, hemophthalmos) both during surgery and in the early postoperative period ( Fig. 2)
.
Figure 2. Fig.
2. Hyphema in the early postoperative period after drainage surgery. It was shown that the synthetic prostamide bimatoprost did not increase the incidence of hemorrhagic complications in the early postoperative period in operated patients. Only in three (21.4%) cases out of 14 were hemorrhagic complications recorded, whereas with conventional drainage surgery, hemorrhagic complications occur on average in 24.5% of cases [5].
The following drugs reduce the production of aqueous humor:
- α2-adrenergic receptor agonists;
- carbonic anhydrase inhibitors;
- β-blockers.
α2-adrenergic receptor agonists
- Clonidine (clonidine),
- Brimonidine is a drug that reduces intraocular pressure more effectively than clonidine. These drugs have a dual mechanism for reducing intraocular pressure - they reduce the production of ocular fluid and cause the ciliary muscle to contract, which helps improve its outflow.
Carbonic anhydrase inhibitors
- dorzolamide hydrochloride (Trusopt),
- brinzolamide (Azopt).
These drugs block the ciliary body enzyme, carbonic anhydrase. This reduces the production of aqueous humor, and as a result, a decrease in intraocular pressure occurs.
β-blockers
- Proxodolol,
- Timolol (arutimol, okumed, timohexal).
These drugs are contraindicated for concomitant corneal dystrophy, dry keratitis, bradyarrhythmia and bronchial asthma.
Prices and reviews
In addition to the potential risk of extraneous reactions, the disadvantages of the product include its high cost. Economical consumption and high efficiency help reduce the unpleasant impression of visiting a pharmacy.
There are cases when girls use drops not for their intended purpose, but to improve the quality of eyelashes. Such “self-medication” is unacceptable and dangerous to health. The composition should be used on the recommendation of a doctor.
Headaches cannot be tolerated - treatment of ocular migraines.
These and other features of taking the medicine can be identified in patient reviews:
- Tamara Albanova: “I’ve been using the drug Ganfort for 2 years now, my vision has improved, but I have tinnitus... Of course, it’s unpleasant, but I tried to change the medicine with my doctor, but it didn’t suit me.”
- Sudoku: “Grandma is dripping, she has glaucoma in 1 eye. Now one eye is blue, the other is brown.”
Read how to treat internal stye on the eye here.
| Ganfort | 812 rub. |
| Timolol | 258 rub. |
| Xalacom | 664 rub. |
| Betoptik | 384 rub. |
| Azarga | 967 rub. |
Find out the causes and treatment of eyelash loss in women by following the link.
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Negative companions of treatment
The drug can enter the circulatory system and contribute to the development of adverse reactions, both from the visual side and general to the whole body.
According to studies, the following manifestations often occur (from 1 to 10% of cases):
- burning sensation, foreign body;
- pain, itching, redness;
- keratitis, corneal erosion;
- itching and pigmentation of the skin of the eyelashes.
After a course of use, the color of the iris may change, in some cases it lasts for life. When the drug is instilled into only one organ, visible differences sometimes appear.
Rhinitis, headache, hirsutism (excessive hair growth) are less likely to occur, as well as eye irritation, blepharitis, swelling, and deterioration of visual acuity.
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Contraindications
The substances included in the composition determine not only its effectiveness, but also its prohibitions. Ganfort is a medicine whose uncontrolled use is unacceptable.
So, it is prohibited to use the product in the following cases:
- under 18 years of age, pregnant and lactating women;
- in the presence of intolerance to any component;
- the presence of diseases of the respiratory system (bronchial asthma, chronic obstructive pulmonary disease) and heart (failure, cardiogenic shock, bradycardia, blockade of 2 and 3 degrees).
Long-term use in the presence of corneal damage (dry eye syndrome and others) requires careful monitoring. This is due to the compound benzalkonium chloride, which can cause keratitis or ulcers of the membrane.
Since the effect of the drug in people suffering from kidney and liver diseases has not been carried out to the proper extent, the prescription is allowed, but requires the attention and constant supervision of a doctor. The situation is similar in patients at risk of macular edema (yellow spot on the retina), which is possible with aphakia and lens rupture.
For diabetes and impaired glucose tolerance, the medicine can hide the symptoms of hypoglycemia, and therefore also requires extreme caution.
The first sign of glaucoma development
The “terrible” diagnosis of dacryocystitis is inflammation of the lacrimal sac.
