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Optimization of diagnosis and treatment options in patients with primary open-angle glaucoma

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Category: #1 (03) 2016
Published: 24 August 2016
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 Abysheva L. D.1, Alexandrov A. S.2, Arapiev M. U.3, Ardzheneshvily T. D.4, Bakunina N. A.5, Basinsky A. S.6, Brezhnev A. Yu.7, Gazizova I. R.8, Galimova A. B.9, Gapon’ko O. V.2, 5, Garkavenko V. V.10, Gorodnichy V. V.2, Gorshkova M. S.5, 12, Gusarevitch A. A.12, Dorofeev D. A.13, Zavadsky P. Ch.14, Zakharova M. A.2, 5, Zakhidov A. B.15, Zvereva O. G.16, Karimov U. R.17, Kondrakova I. V.5, Kuroyedov A. V.2, 5, Lanin S. N.18, Lipatov D. V.19, Lovpache Dzh. N.3, Loskutov I. A.20, Molchanova E. V.21, Ogorodnikova V. Yu.2, Onufriychuk O. N.22, Petrov S. Yu.23, Rozhko Yu. I.24, Tashtitova L. B.1, Khohlova A. S.25, Shaposhnikova I. V.26, Shahalova A. P.27

1Scientific State Ophthalmology Institute, Almaty, Kazakhstan; 2Mandryka Central Clinical Hospital, Moscow, Russia; 3Helmgoltz State Research Ophthalmology Institute, Moscow, Russia; 4Federal Clinical Hospital no. 86, Moscow, Russia; 5Pirogov City State Clinical Hospital no. 1, Moscow, Russia; 6Prof. Basynsky Private Ophthalmology Center, Ltd., Orel, Russia; 7State Medical University, Kursk, Russia; 8North-West Federal Medical and Research Center, Saint-Petersburg, Russia; 9All-Russian Eye and Plastic Surgery Center, Ufa, Russia; 10Voyno-Yasenetsky State Medical University, Krasnoyarsk, Russia; 11Filatov City State Clinical Hospital no. 15, Moscow, Russia; 12Regional Railroad Clinical Hospital, Novosibirsk, Russia; 13Regional Ophthalmology Clinical Hospital no. 3, Chelyabinsk, Russia; 14Medical Center “New Vision” Minsk, Belarus; 15Ophthalmosurgery Medical Center “SAIF-OPTIMA”, Tashkent, Uzbekistan; 16Region Clinical Ophthalmology Hospital, Kazan, Russia; 17Region Ophthalmology Hospital, Gulistan, Uzbekistan; 18Makarov Ophthalmology Clinical Hospital, Krasnoyarsk, Russia; 19Federal Medical Center of Endocrinology, Moscow, Russia; 20Russian Railways Clinical and Research Medical Center, Moscow, Russia; 21State Medical Academy, Omsk, Russia; 22Ophthalmic Diagnostic City Center no. 7, Saint-Petersburg, Russia; 23Scientific and Research State Ophthalmology Institute, Moscow, Russia; 24State Hospital, Gomel, Belarus; 25Pacific State Medical University, Vladivostok, Russia; 26Medical Clinical Center “Good Vision”, Kemerovo, Russia; 27Medical Clinical Center “Tonus Amaris”, Nizhny Novgorod, Russia 

Abstract

 Purpose. To create an optimal scientifically based system of management of diagnosis and treatment process (diagnosis, follow-up, rational medication treatment, surgical treatment) in patients with primary open-angle glaucoma.

 Methods. The final protocol of combined analytical research and clinical multicenter study conducted from July to November 2015 included data from 591 patients (824 eyes). Age, disease duration, disease stage, the intraocular pressure (IOP) level and visual field parameters on the top of treatment regimens were analyzed. The term “regimen” included various combinations of medical, laser and surgical treatment used in the disease management.

 Results. Average patients’ age at the diagnosis was 64.3 (57.5; 70.4). Mean disease duration was 4.1 years (2.0; 7.1). The administered regimen was considered to be effective when IOP level was below 20 mm hg. The IOP level between 21 and 25 mm hg was considered to be a sign of reduced treatment effectiveness and need for change of the regimen.

 In total there were analyzed 8 regimen changes, though 90 % of cases had 1–5 regimen changes. The first three regimens were used for 1.2 (0.4; 2.6), 1.3 (0.5; 2.5) and 1.1 (0.5; 2.4) years respectively.

Prostaglandin analogues and β-blockers monotherapy was used as a first-line in 40.1 % and 20.8 % of cases respectively. Treatment was started with combination therapy in 27.82 % of cases. Proportion of surgical treatment was 9.9 % in regimen 2 and achieved 73 % in regimen 5. Laser treatment was started from regimen 3 though the frequency of administration did not exceed 20 %. Combination treatment using 3 and more components was found starting from regimen 5 (57.3 %). 

 Conclusion. First-line therapy choice is still not rational in many cases. Laser and surgical treatment are used ineffectively after 3–4 years from the diagnosis.

 Keywords: glaucoma, treatment regimen, rational medication therapy, tolerance, diagnosis and treatment process.

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Received: 12 Nov. 2015

Published: April 2016