Abysheva L. D.¹, Avdeev R. V.², Alexandrov A. S.³, Basinsky A. S.⁴, Blyum E. A.⁵, Brezhnev A. Yu.⁶, Gazizova I. R.⁷, Galimova A. B.⁸, Gaponko O. V.³, Garkavenko V. V.⁹, Getmanova A. M.¹⁰, Gorodnichy V. V.³, Gorshkova M. S.^{11, 12}, Gusarevitch A. A.¹³, Dorofeev D. A.¹⁴, Zhavoronkov S. A.¹¹, Zavadsky P. Ch.¹⁵, Zakhidov A. B.¹⁶, Zvereva O. G.¹⁷, Karimov U. R.¹⁸, Kulik A. V.¹⁹, Kuroyedov A. V.^{3, 12}, Lanin S. N.²⁰, Lovpache Dzh. N.²¹, Loskutov I. A.²², Molchanova E. V.²³, Nefedov N. A.³, Ogorodnikova V. Yu.³, Onufrichuk O. N.²⁴, Openkova E. Yu.²⁵, Petrov S. Yu.²⁶, Rozhko Yu. I.²⁷, Sidenko T. A.²⁸, Tashtitova L. B.¹, Fomin N. E.¹², Khudzhatova M. S.¹

¹Scientific State Ophthalmology Institute, Almaty, Kazakhstan; ²Burdenko State Medical Academy, Voronezh, Russia; ³Mandryka Medicine and Clinical Center, Moscow, Russia; ⁴Prof. Basynsky Ophthalmology Center, Ltd., Orel, Russia; ⁵Ophthalmology Hospital, Shymkent, Kazakhstan; ⁶State Medical University, Kursk, Russia; ⁷State Medical University, Ufa, Russia; ⁸Russian Eye and Plastic Surgery Center, Ufa, Russia; ⁹VoynoYasenetsky State Medical University, Krasnoyarsk, Russia; ¹⁰Regional Eye Hospital, Bryansk, Russia; ¹¹Filatov City Clinical Hospital no. 15, Moscow, Russia; ¹²Pirogov Russian National Research Medical University, Moscow, Russia; ¹³Regional Road Clinical Hospital, Novosibirsk, Russia; ¹⁴Ophthalmology Hospital no. 3, Chelyabinsk, Russia; ¹⁵State Medical University, Grodno, Belarus; ¹⁶Eye-Microsurgery Clinic “SAIFOPTIMA”, Tashkent, Uzbekistan; ¹⁷Region Clinical Ophthalmology Hospital, Kazan, Russia; ¹⁸Region Ophthalmology Hospital, Gulistan, Uzbekistan; ¹⁹“Meditsina” Medical Center, Moscow; ²⁰Makarov Ophthalmology Clinical Hospital, Krasnoyarsk, Russia; ²¹Helmgoltz State Ophthalmology Institute, Moscow, Russia; ²²Semashko State Ophthalmology Hospital, Moscow, Russia; ²³State Medical Academy, Omsk, Russia; ²⁴Ophthalmic Diagnostic Center no. 7, Saint-Petersburg, Russia; ²⁵South-Ural State Medical University, Chelyabinsk, Russia; ²⁶Scientific State Ophthalmology Institute, Moscow, Russia; ²⁷State Hospital, Gomel, Belarus; ²⁸City Government Hospital no. 5, Perm, Russia 

Abstract

Background. Studies in the field of distinction between normal and pathological intraocular pressure (IOP) level in healthy subjects and glaucoma patients are being held for the last several decades.

Objective. To study the IOP characteristics in patients with primary open-angle glaucoma on treatment in order to find out the disease progression and to determine the optimal IOP levels. 

 Material and methods. The final protocol included data from 812 right eyes of 637 glaucoma patients and 175 healthy subjects; the latter formed the control group. The average age of the examined was 71.8 ± 0.28 years; 72.00 (66.00; 77.00). Mean disease duration in glaucoma patients was 5.41 ± 0.17 years. The following parameters were assessed: visual acuity, clinical refraction, IOP level by Maklakov tonometry, central corneal thickness and IOP-lowering medication use.

 Results. The levels of IOP were 20.97 ± 0.31, 19.98 ± 0.15, 19.63 ± 0.25 mm Hg in the age group 60 to 69 years respectively for patients with advanced, developed stages of glaucoma and healthy subjects. In patients with advanced stages of glaucoma, IOP level was significantly higher than in patients with advanced-stage disease (p = 0.002) and healthy subjects (p < 0.001).

 There was no significant difference in central corneal thickness either between glaucoma patients and healthy subjects (both male and female) or between glaucoma patients with different glaucoma changes. The IOP level was higher in patients treated with non-fixed combination of beta-blockers and prostaglandins regardless of the disease stage.

 Target values of IOP levels in patients with advanced glaucoma (≤ 21 mm Hg) were achieved in 69.93 % of patients, and the values of ≤ 18 mm Hg – in 14.42 % of patients with an advanced stage. Thus, it was found that only 51.81 % of patients had levels safe IOP and glaucomа optic neuropathy stabilization persisted throughout 3.60 ± 0.14, with the transition to the next stage through 7.13 ± 0.28 years.

Conclusion. The results of the study could be used as clinical guidelines for determination of the optimal IOP range, choosing the optimal IOP-lowering medication(s) for starting therapy and during the follow-up in patients with moderate and advanced glaucoma changes. 

 Keywords: glaucoma, intraocular pressure level, central corneal thickness, IOP-lowering medications.

REFERENCES

1. Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., et al. Risk factors, pathogenic factors of development and progression of the results of a multicenter study of Russian society glaucoma. Mediko-biologicheskie problemy zhiznedeyatelnosti [Medical and biological problems of vital functions]. 2012; (2): 57–69 (in Russian).
2. Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., et al. Clinical multicenter study of the effectiveness of trabeculectomy. Glaukoma [Glaucoma]. 2013; (2): 53–60 (in Russian).
3. Kuroedov A. V. Clinical and economic approaches in the treatment of patients with glaucoma. Oftalmologicheskie vedomosti [Ophthalmological journal]. 2010; (1): 51–62 (in Russian).
4. Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., et al. The degree of mutual influence and the relationship between morphological and functional characteristics of primary open-angle glaucoma and macular degeneration. Oftalmologicheskie vedomosti [Ophthalmic statements]. 2014; (1): 19–27 (in Russian).
5. Avetisov S. E., Petrov S. Yu., Bubnova I. A., et al. Influence of central corneal thickness on the tonometry results. Vestnik oftalmologii [Bulletin of ophthalmology]. 2008; (5): 3–7 (in Russian).
6. Avetisov S. E., Mamikonyan V. R., Kazaryan E. E., Shmeleva-Demir O. A. The results of the clinical evaluation of a new screening method for determining an individual rate of intraocular pressure. Vestnik oftalmologii [Bulletin of ophthalmology]. 2010; (2): 5–8 (in Russian).
7. Alekseev V. N., Egorov E. A., Martynova E. B. Intraocular pressure levels distribution in normal population. RMZh. Klinicheskaya Oftalmologiya [RMJ. Clinical ophthalmology]. 2001; (2): 38–40 (in Russian).
8. Alekseev V. N., Litvin I. B. The relationship of pachymetric indicators and the level of IOP among the healthy population and patients with primary open-angle glaucoma. Glaukoma [Glaucoma]. 2009; (4): 17–20 (in Russian).
9. Arutyunyan L. L. The role of the biomechanical properties of the eye in determining the target pressure. Glaukoma [Glaucoma]. 2007; (3): 60–67 (in Russian).
10. Astakhov Yu. S., Akopov E. L., Potemkin V. V. Comparative characteristics of modern methods of tonometry. Vestnik oftalmologii [Bulletin of ophthalmology]. 2008; (5): 11–14 (in Russian).
11. Balalin S. V., Fokin V. P. On the issue of tolerance and intolerance to the optic nerve inside the eye pressure in glaucoma. RMZh. Klinicheskaya Oftalmologiya [RMJ. Clinical ophthalmology]. 2009; (4): 128–132 (in Russian).
12. Bikbov M. M., Gabdrakhmanova A. F., Orenburkina O. I., et al. Influence of corneal thickness on the performance of intraocular pressure in patients with glaucoma. Vestnik oftalmologii [Bulletin of ophthalmology]. 2008; (5): 7–10 (in Russian).
13. Vodovozov A. M. Tolerance and intolerance intraocular pressure in glaucoma. Volgograd, BI, 1991, 160 p. (in Russian).
14. Volkov V. V., Sukhinina L. B., Ustinova E. I. Glaucoma, preglaukoma, ophthalmohypertension. Leningrad, Meditsina, 1985, 216 p. (in Russian).
15. Egorov E. A., Vasina M. V. Influence of corneal thickness on intraocular pressure levels among different groups of patients. RMZh. Klinicheskaya Oftalmologiya [RMJ. Clinical ophthalmology]. 2006; (1): 16–19 (in Russian).
16. Egorov E. A., Kuroyedov A. V. Individual clinical and epidemiological characteristics of glaucoma in CIS countries and Georgia. Results of a multicenter open retrospective study (part 1). RMZh. Klinicheskaya Oftalmologiya [RMJ. Clinical ophthalmology]. 2011; (3): 97–100 (in Russian).
17. 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).
18. Eremina M. V., Erichev V. P., Yakubova L. V. Effect of the central corneal thickness to the level of intraocular pressure in normal and glaucomatous. Glaukoma [Glaucoma]. 2006; (4): 78–83 (in Russian).
19. Eremina M. V. Biomechanical properties of the cornea in primary open-angle glaucoma. Vestnik oftalmologii [Bulletin of ophthalmology]. 2008; (5): 16–19 (in Russian).
20. Zayko N. N., Mints S. M. Intraocular pressure and its regulation. Kyiv, Zdorovie, 1966, 296 p. (in Russian).
21. Katargina L. A., Kiseleva O. A., Arutyunyan L. L., Filippova O. M. The value of central corneal thickness in the progression of primary open-angle glaucoma. Novosti glaukomy [Glaucoma news]. 2010; (1): 3–5 (in Russian).
22. Kozlova L. P., Sporova N. A., Leonov S. A. Characteristics of the course and I stage of openangle glaucoma. Vestnik oftalmologii [Bulletin of ophthalmology]. 1983; (2): 14–15 (in Russian).
23. Kuroyedov A. V., Gorodnichiy V. V. Central corneal thickness as a risk factor for the progression of primary open-angle glaucoma. Glaukoma [Glaucoma]. 2008; (4): 20–28 (in Russian).
24. Neroev V. V., Kiseleva O. A., Bessmertnyy A. M. The main results of a multicenter study of epidemiological characteristics of primary open-angle glaucoma in the Russian Federation. Rossiyskiy oftalmologicheskiy zhurnal [Russian ophthalmological journal]. 2013; (3): 4–7 (in Russian).
25. Nesterov A. P., Egorov E. A. On the pathogenesis of glaucomatous optic nerve atrophy. Oftalmologicheskiy zhurnal [Journal of ophthalmology]. 1979; (7): 419–422 (in Russian).
26. Nesterov A. P. Glaucomous optic neuropathy. Vestnik oftalmologii [Bulletin of ophthalmology]. 1999; (4): 3–6 (in Russian).
27. Panina N. B. Norms of intraocular pressure. In: Glaucoma and other eye diseases. Leningrad, 1971, pp. 7–12 (in Russian).
28. Fayzrakhmanov R. R., Sobyanin N. A., Volkov A. A., Fayzrakhmanova O. A. Individual dependence of intraocular pressure in normal corneal thickness. Glaukoma [Glaucoma]. 2001; (3): 3–6 (in Russian).
29. Doughty M. J., Zaman M. L. Human corneal thickness and its impact on intraocular pressure measures: a review: a meta-analysis approach. Survey of Ophthalmology. 2000; 44(5): 367–408.
30. Ehlers N., Bramsen T., Sperling S. Applanation tonometry and central corneal thickness. Acta Ophthalmologica (Copenhagen). 1975; 53(1): 34–43.
31. Gordon M. O., Beiser J. A., Brandt J. D., et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open angle glaucoma. Archives of Ophthalmology. 2002; 120(6): 714–720.
32. Herndon L. W., Lee D. A., Netland P. A. Rethinking pachymetry and intraocular pressure. Review of Ophthalmology. 2002; 2(1): 88–90.
33. Realini T., Barber L., Burton D. Frequency of asymmetric intraocular pressure fluctuations among patients with and without glaucoma. Ophthalmology. 2002; 109(7): 1367–1371.
34. Shah S., Chatterjee A., Mathai M., et al. Relationship between corneal thickness and measurement intraocular pressure in general ophthalmology clinic. Ophthalmology. 1999; 106(11): 2154–2160.
35. Varma R., Hwang L.-J., Grunden J. W., Bean G. W. Inter-visit intraocular pressure range: an alternative parameter for assessing intraocular pressure control in clinical trials. American Journal of Ophthalmology. 2008; 145(2): 336–342.
36. Whitacre M. M., Stein R. A., Hassanein K. The effect of corneal thickness in applanation tonometry. American Journal of Ophthalmology. 1993; 115(5): 592–596.

Received: 7 Apr. 2016

Published: December 2016