The correct choice of monotherapy with prostaglandin analogues/ prostamides at the start of treatment for newly diagnosed glaucoma (results of a multicenter study)

PURPOSE: To establish the hypotensive effectiveness of the appointment of monotherapy with prostaglandin analogues/prostamide as the «starting» therapy for clinic stages of primary open-angle glaucoma (POAG) and the feasibility of combining them with local carbonic anhydrase inhibitors to correct the treatment regimen if necessary.

METHODS: A multicenter analytical cohort sample scientific prospective dynamic study was conducted on 30 scientific and clinical bases in 4 countries from December

2019 to February 2020. The study included patients with primarily diagnosed glaucoma (different stages, except terminal stage) — 60 patients (60 eyes). The eyes with the most pronounced glaucoma changes were the main focus of the study. Gender distribution: male — 31 (51.7%), female — 29 (48.3%), average age — 64 years. POAG diagnosis was verified by static computer perimetry, intraocular pressure (IOP) values and morphometric data of the optic disc. Measurement of the central thickness of the cornea in the optical zone and the thickness of the retinal nerve fibre layer via оptical coherence tomography was additional. We studied the tonometric and pneumotonometric IOP at the day of glaucoma diagnosis verification, one day after, 14 and 30 days after the therapy start. Monotherapy with prostaglandin analogues was offered to all patients as starting therapy. Local carbonic anhydrase inhibitors were used as additive therapy if necessary. Treatment correction was carried out 14 days after the therapy start.

RESULTS: The average IOP in all stages was 27.5 [24; 31] mm Hg, and 2 weeks after the appointment of prostaglandin analogues, it decreased to 20 [19; 21] mm Hg. IOP decrease percentage amounted to 26.9% [33.3; 19.1] of the initial values. Optimal IOP has achieved in 46 of 60 patients (76.7%). These were mainly patients with an early stage of POAG. By the end of the second week of treatment, 14 patients (25%) needed additional hypotensive therapy using local carbonic anhydrase inhibitors. On day 30 without the use of additional therapy, IOP level reduced by 28.8% [33.3; 19.2], and in patients with combination therapy by 32.75% [41.9; 23.7].

CONCLUSION: This study confirmed the feasibility of using a differentiated («stepwise») approach to the treatment of patients with different clinical stages of first-time diagnosed POAG.

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