COMPARISON OF TREATMENT REGIMENS FOR PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA WITH SIGNS OF DISEASE PROGRESSION. Part 1. IOP levels

PURPOSE: To determine the effect of some IOP level indicators on disease progression in patients with primary open-angle glaucoma.

METHODS: This combined, analytical scientific and clinical multicenter cohort study was conducted between January and April 2017. A total of 136 participants (237 eyes) from 30 academic referral centers from 6 (six) countries (Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Uzbekistan) were enrolled — 52 (38.2%) males and 84 (61.8%) females. As a first step, glaucoma anamnesis and all treatment strategies were retrospectively evaluated. Glaucoma was diagnosed according to the differential diagnosis system and confirmed by special methods in all cases. All data concerning the stage of disease were verified repeatedly at the start of the study according to the current glaucoma classification and with additional IOP measurements (Maklakov tonometer, 10 g), morphometric and functional indicators research.

RESULTS: The history of the disease at the time of the final examination for patients with different stages of glaucoma was comparable in time and averaged 4.3 (3.7, 5.8) years. Over the average follow-up period, the initial stage did not progress in 73.37% of mild glaucoma cases, 19.02% of cases have progressed to moderate glaucoma, 4.35% have progressed to advanced glaucoma, 3.26% — to terminal glaucoma. Moderate glaucoma stage was preserved in 59.52% cases, in 33.33% it progressed to advanced glaucoma, in 7.15% — to terminal glaucoma. Advanced glaucoma stage remained without a progress in 54.55% cases, in 45.45% cases it has progressed to terminal glaucoma during 5 years. Mean IOP level after follow-up period was 19 (17; 21) mm Hg and had no significant difference (p=0.557, H=2.073). Consequently, only in early-stage glaucoma cases the average «inter-visit» IOP value corresponded with values recommended as a target IOP by the Russian Glaucoma Society, whereas in other cases (moderate and advanced glaucoma) it was significantly higher. There was no significant difference (p=0.597, H=1.882) between «optimal» IOP-level in patients with different glaucoma stages, and «intolerant» IOP-level increased from stage to stage (p<0.001, H=32.175). The initial regimen was generally effective for patients with mild glaucoma with IOP level increase registered only in 2.17% cases. «Inter-visit» IOP-level was above recommended values in 38.1% cases in patients with moderate primary open-angle glaucoma, and in 81.82% in patients with advanced primary open-angle glaucoma. The analysis of visual field change during the follow-up period showed that MD increased in 29.5% cases and decreased in 70.5% cases.

CONCLUSION: In this paper we assessed IOP level not only using classical methods, but also introducing new terminology, such as the «inter-visit» IOP-level, the «optimal» IOP-level, the «intolerant» IOP-level, to characterize the IOP dynamics in different time intervals. The results of the study suggest that inter-visit IOP range can be one of the possible predictors of glaucomatous damage, and therefore can be useful for correction of existing clinical guidelines.

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