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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.

 REFERENCES

  1.  Egorov E. A., Astakhov Yu. S., Erichev V. P. National guidelines for glaucoma for medical practitioners. Moscow, GEOTAR-Media, 2015, 454 p. (in Russian).
  2. Egorova I. V., Shamshinova A. M., Erichev V. P. Functional methods in the glaucoma diagnostics. Vestnik oftalmologii [Bulletin of ophthalmology]. 2001; (117): 38–40. (in Russian).
  3. Shchuko A. G., Yur’eva T. N. Algorithms for diagnosis and treatment of patients with primary glaucoma. Irkutsk, RIO IGIUVa, 2009, 88 p. (in Russian).
  4. Brezhnev A. Yu., Kurysheva N. I., Trubilin V. N., Baranov V. I. Problems of early clinical diagnosis of the pseudoexfoliative syndrome. Oftalmologiya [Ophthalmology]. 2012; (9): 49–52. (in Russian).
  5. Erichev V. P., Petrov S. Yu., Kozlova I. V., Makarova A. S., Reshchikova V. S. Modern methods of functional diagnostics and monitoring of glaucoma. Part 1. Perimetry as a functional diagnostics method. Natsional’nyi zhurnal glaucoma [National journal of glaucoma]. 2015; (14): 75–81. (in Russian).
  6. Erichev V. P., Petrov S. Yu., Kozlova I. V., Makarova A. S., Reshchikova V. S. Modern methods of functional diagnostics and monitoring of glaucoma. Part 1. Diagnosis of structural damage of the retina and optic nerve. Natsional’nyi zhurnal glaucoma [National journal of glaucoma]. 2015; (14): 72–79. (in Russian).
  7. Astakhov Yu. S., Rakhmanov V. V. Heredity and glaucoma. Oftalmologicheskie vedomosti [Ophthalmic statements]. 2012; (4): 51–57. (in Russian).
  8. Kuroedov A. V., Erichev V. P., Khodykina N. P., Gorodnichii V. V., Khodykina N. P. Correlation relationship between daily fluctuations in intraocular pressure and morphometric structure of the optic nerve. Oftalmologiya [Ophthalmology]. 2006; (3): 43–49. (in Russian).
  9. Kuroedov A. V., Brezhnev A. Yu., Aleksandrov A. S., Ogorodnikova V. Yu. Principles of treatment of early stage of glaucoma: treatment against surgery (review). Voenno-meditsinskiy zhurnal [Military medical journal]. 2011; (332): 28–35. (in Russian).
  10. Petrov S. Yu., Antonov A. A., Makarova A. S., Vostrukhin S. V. IOP in the assessment of medical and surgical treatment of glaucoma. RMZh. Klinicheskaya oftalmologiya [RMJ. Clinical ophthalmology]. 2015; (16): 69–72. (in Russian).
  11. Astakhov Yu. S., Ustinova E. I., Katinas G. S., Ustinov S. N., Baygusheva S. S. On traditional and modern methods of study IOP fluctuations. Oftalmologicheskie vedomosti [Ophthalmic statements]. 2008; (1): 7–12. (in Russian).
  12. Egorov E. A., Kuroyedov A. V. Clinical and epidemiological characteristics of glaucoma in CIS and Georgia. Results of multicenter opened retrospective trial (part 1). RMZh. Klinicheskaya oftalmologiya [RMJ. Clinical ophthalmology]. 2011; (3): 97–100. (in Russian).
  13. Egorov E. A., Kuroyedov A. V. Clinical and epidemiological characteristics of glaucoma in CIS and Georgia. Results of multicenter opened retrospective trial (part 2). RMZh. Klinicheskaya oftalmologiya [RMJ. Clinical ophthalmology]. 2012; (1):19–22. (in Russian).
  14. Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gaponko O. V., Gorodnichiy V. V., Dorofeev D. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A., Tazhibaev T. Dzh., Shepeleva A. V. Risk factors, pathogens development and progression of the results of a multicenter study of Russian glaucoma society. Meditsinskie i biologicheskie problemy zhiznedeyatel’nosti [Medical and biological problems of life]. 2012; (8): 57–69. (in Russian).
  15. Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gaponko O. V., Gorodnichiy V. V., Dorofeev D. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A., Tazhibaev T. Dzh., Shepeleva A. V. Clinical multicenter study of trabeculectomy efficacy. Natsional’nyi zhurnal glaucoma [National journal of glaucoma]. 2013; (12): 53–55. (in Russian).
  16. Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gaponko O. V., Gorodnichiy V. V., Dorofeev D. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A., Tazhibaev T. Dzh., Shepeleva A. V. The degree of mutual influence and the relationship between morphological and functional characteristics of primary openangle glaucoma and macular degeneration. Oftalmologicheskie vedomosti [Ophthalmic statements]. 2014; (1): 19–27. (in Russian).
  17. Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Diordiychuk S. V., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Nefedov N. A., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A. Prediction of the duration of the disease and the age of patients with different stages of primary open-angle glaucoma. Natsional’nyi zhurnal glaucoma [National journal of glaucoma]. 2014; (13): 60–69. (in Russian).
  18. Abysheva L. D., Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zakhidov A. B., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache D. N., Loskutov I. A., Molchanova Ye. V., Nefedov N. A., Ogorodnikova V. Yu., Onufriychuk O. N., Openkova Ye. Yu., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A., Tashtitova L. B., Fomin N. Ye., Khudzhatova M. S. Multicenter study of intraocular pressure level in patients with moderate and advanced primary open-angle glaucoma on treatment. Oftalmologicheskie vedomosti [Ophthalmic statements]. 2015; (1): 52–69. (in Russian).
  19. Kuroedov A. V., Abysheva L. D., Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zakhidov A. B., Zvereva O. G., Karimov U. R., Kulik A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Nefedov N. A., Ogorodnikova V. Yu., Onufriychuk O. N., Openkova Ye. Yu., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A., Tashtitova L. B., Fomin N. Ye., Khudzhatova M. S. The results of the study and cost effectiveness ratio of costs in the application of local hypotensive therapy in patients with advanced primary open-angle glaucoma (multicenter study). Rossiyskiy oftalmologicheskiy zhurnal [Russian ophthalmological journal]. 2015; (3): 10–22. (in Russian).
  20. Abysheva L. D., Avdeev R. V., Aleksandrov A. S., Bakunina N. A., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Gazizova I. R., Galimova A. B., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gusarevich A. A., Dorofeev D. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kuroedov A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Nefedov N. A., Onufriychuk O. N., Openkova Ye. Yu., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A., Tashtitova L. B., Fomin N. Ye., Khudzhatova M. S. Optimum performance of the upper limit of IOP in patients with advanced stage primary open-angle glaucoma in terms of evidence-based medicine. RMZh. Klinicheskaya oftalmologiya [RMJ. Clinical ophthalmology]. 2015; (3): 111–123. (in Russian).
  21. Kuroedov A. V., Avdeev R. V., Aleksandrov A. S., Bakunina N. A., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Diordiychuk S. V., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A. Primary open-angle glaucoma: the age at which the patient and duration of disease which may occur blindness. Mediko-biologicheskie problemy zhiznedeyatelnosti [Medical and biological problems of life]. 2014; (12): 74–84. (in Russian).
  22. Avdeev R. V., Aleksandrov A. S., Bakunina N. A., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Diordiychuk S. V., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A. Model of outcomes of primary open angle glaucoma. Klinicheskaya meditsina [Clinical medicine]. 2014; (92): 64–72. (in Russian).
  23. Avdeev R. V., Aleksandrov A. A., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Diordiychuk S. V., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache D. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A. Prediction of the duration of the disease and the age of patients with different stages of primary open angle glaucoma. Natsional’nyi zhurnal glaucoma [National journal of glaucoma]. 2014; (13): 60–69. (in Russian).
  24. Kuroedov A. V., Avdeev R. V., Aleksandrov A. S., Bakunina N. A., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Diordiychuk S. V., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A. The estimated age of the patients and the period of the disease to intensive treatment and prevention of manipulation in primary glaucoma. Oftalmologiya. Vostochnaya Yevropa [Ophthalmology. Eastern Europe]. 2014; (22): 60–71. (in Russian).
  25. Egorov E. A. (ed.) Rational pharmacotherapy in ophthalmology: a guide for practitioners. Moscow, Litterra, 2004, 954 p. (in Russian).

Received: 12 Nov. 2015

Published: April 2016