Hypotensive regimens providing target intraocular pressure in patients with primary open-angle glaucoma (results of a multicenter analytical study)

PURPOSE: To determine the effectiveness of primary open-angle glaucoma (POAG)  treatment based on the assess-ment of hypotensive regimens used to achieve "target" intraocular pressure (IOP) depending on the clinical stage of the disease.

METHODS: Analytical multicenter study was conducted based on the results of a survey of 51 ophthalmologists. Each specialist solved 18 tasks, determining the "target" level of IOP, hypotensive regimen and further tactics de-pending on preset parameters.

RESULTS: “Target” values for stage I of POAG was 22 mm Hg; 20 mm Hg — for stage II of POAG; 18 mm Hg — for stage III of POAG. “Convenient” target values equaled 19.2±0.26 mm Hg for stage I; 19.02±0.23 mm Hg — for stage II and 17.35± 0.21 mm Hg for stage III. “Inconvenient” values, i.e. requiring  changing or enhancing therapy, were 23.98±0.38 mm Hg for stage I; 23.63±0.29 mm Hg — for II; 22.86±0.28 — for stage III. “Extremely inconvenient” values and the indication for surgery were 27.2±0.45 mm Hg for stage I; 26.14±0.34 mm Hg for stage II and 25.97±0.42 mm Hg — for stage III. The therapy changed if IOP was increased by 9% in stage I, 20% in II and 22% in stage III; the transition to surgery was made if the increase reached 23% in patients with stage I, 30% in II and 39% in stage III of POAG. The average transition period from drug therapy to surgery was 4 years.

CONCLUSION: The achievement of "target" IOP was ensured by the use of severe hypotensive regimens that included up to 3-4 drugs. Perhaps this is an additional argument for further improvement of POAG treatment algorithms, justifying an earlier and more active use of surgical methods of IOP correction. However, a high level of evidence base practice of their efficacy and safety must be provided.

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