The efficacy of first-choice therapy in the treatment of newly diagnosed primary glaucoma
Abstract
PURPOSE: To analyze the initial treatment for newly diagnosed primary open-angle glaucoma (POAG) I-III stages, to assess its efficacy and the extent of IOP level reduction.
METHODS: The study included 597 patients (1 194 eyes) with newly diagnosed mild to advanced POAG, 186 men (31.1%) and 411 women (68.9%) with mean age of 63.9±1.97 years. Study protocol included the following indicators assessment: age, medical history (comorbidity), disease stage, IOP level — initial, 2 weeks, 1, 3, 6 months and 1 year after the hypotensive treatment onset, hypotensive drug regimen and its changes.
RESULTS: 93.6% of POAG patients had concomitant somatic diseases. Beta-blockers (BB) were used as the firstline drug in mild glaucoma in 75.4% of cases, in moderate glaucoma — in 35.6%. Prostaglandin analogues (PA) monotherapy was prescribed in 17.8% of cases in mild glaucoma, 14.1% in moderate glaucoma and 16.0% — in advanced glaucoma. A PA/BB combination was chosen in 14.1% of moderate glaucoma and 33.7% of advanced glaucoma cases. Fixed combinations of these drugs were used in 14.5% and 13.3% of moderate and advanced glaucoma patients respectively. After 12 months of mild glaucoma 40.4% of patients changed their hypotensive regimen, switching from BB to other drugs, glaucoma progression was observed in 7.7% of cases. Hypotensive regimen correction in moderate glaucoma cases was required in over 50% of patients initially instilling BB and 33.3% оf patients adhering to PA monotherapy. In advanced glaucoma patients monotherapy was ineffective in 100% of cases, BB/PA combination showed sufficient effect in 58.7% of cases and their fixed combination — in 45.8%.
CONCLUSION: BB choice as the first-line therapy is not always justified. Active starting therapy in mild glaucoma cases, timely and adequate regimen correction, combination therapy or fixed combinations allow for providing the optimal IOP level at different stages of the disease.
About the Authors
S. I. Makogon
Altai Regional Ophthalmological hospital;
Altai State Medical University
Russian Federation
Russian Federation
Ph.D., Associate Professor, Head of the Ophthalmology Course
8 Sovetskaya st., Barnaul, Russian Federation, 656002;
40 Lenina Ave., Barnaul, Russian Federation, 656038
A. L. Onishchenko
Novokuzneck state institute of advanced medical training, a branch of the Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Med.Sc.D., Professor, Deputy Director for Science
5 Stroiteley Ave., Novokuznetsk, Kemerovo region, Russian Federation, 654005;
L. L. Yatsenko
Rubtsovsk City Hospital No. 3
Russian Federation
Russian Federation
Head of the Ophthalmology Department
13 Lenin Ave., Rubtsovsk, Russian Federation, 658213
O. A. Karmanova
«Vision» Biysk Ophthalmological Centre
Russian Federation
Russian Federation
Ophthalmologist
69 Gorno-Altaiskaya st., Biysk, Russian Federation
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Review
For citations:
Makogon S.I., Onishchenko A.L., Yatsenko L.L., Karmanova O.A. The efficacy of first-choice therapy in the treatment of newly diagnosed primary glaucoma. National Journal glaucoma. 2018;17(2):28-37. (In Russ.)
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