Safety characteristics of the established optimal values of the intraocular pressure upper limit in patients with advanced primary open-angle glaucoma in terms of evidence-based medicine

    Abstract

    

    Abysheva L.D., Avdeev R.V. , Alexandrov A.S. ,Bakunina N.A., Basinsky A.S., Blyum E.A. , Brezhnev A.Yu., Gazizova I.R. , Galimova A.B. , Garkavenko V.V., Getmanova A.M., Gorodnichy V.V.3, Gusarevitch A.A. , Dorofeev D.A.,Zavadsky P.Ch., Zvereva O.G., Karimov U.R., Kuroyedov A.V.,, Lanin S.N. , Lovpache Dzh.N. ,Loskutov I.A. , Molchanova E.V. , Nefedov N.A. , Onufrichuk O.N. , Openkova E.Yu. , Petrov S.Yu. , Rozhko Yu.I. , Sidenko T.A. , Tashtitova L.B. , Fomin N.E. , Khudzhatova M.S.

    

    Safety characteristics of the established optimal values of the intraocular pressure upper limit in patients with advanced primary open-angle glaucoma in terms of evidence-based medicine

    

    Scientific State Ophthalmology Institute, Almaty, Kazakhstan;
Burdenko State Medical Academy, Voronezh;
Mandryka Medicine and Clinical Center, Moscow;
Pirogov City State Government Hospital №1, Moscow;
Prof. Basynsky Private Ophthalmology Center, Ltd., Orel;
Ophthalmology Hospital, Shymkent, Kazakhstan;
State Medical University, Kursk;
North-West Federal Medical and Research Center, Saint-Petersburg;
All-Russian Eye and Plastic Surgery Center, Ufa;
Voyno-Yasenetsky State Medical University, Krasnoyarsk;
Regional Eye Hospital, Bryansk;
Regional ReilRoad Clinical Hospital, Novosibirsk;
Ophthalmology Hospital №3, Chelyabinsk;
State Medical University, Grodno, Belarus;
Region Clinical Ophthalmology Hospital, Kazan;
Region Ophthalmology Hospital, Gulistan, Uzbekistan;
Pirogov Russian National Research Medical University, Moscow;
Makarov Ophthalmology Clinical Hospital, Krasnoyarsk;
Helmgoltz State Research Ophthalmology Institute, Moscow;
Russian Railways Clinical and Recearch Medical Center, Moscow;
State Medical Academy, Omsk;
Ophthalmic Diagnostic City Center №7, Saint-Petersburg;
South-Ural State Medical University, Chelyabinsk;
Scientific and Research State Ophthalmology Institute, Moscow;
State Hospital, Gomel, Belarus;
City Government Hospital № 5, Perm; Group of researchers from Russian glaucoma Society «Scientific vanguard», 2011-2015 ©

    

    Background. Discussion about the intraocular pressure (IOP) standards in treated patients with different glaucoma changes has for a long time been accompanied by the discussion about the fixed limits of absolute IOP values.

    Objective. To find out the safe IOP range in treated patients with advanced primary open-angle glaucoma during long-term follow-up.

    Material and methods. The study protocol included data from 78 patients (86 eyes) with advanced glaucoma diagnosed non-later than 01/01/2010. The average patients age at the time of enrollment was 73,48±0,77. The disease duration was 8,62±0,44 years; 7,20 (5,40;10,70) by January-May 2015. The final protocol of routine and additional examination of each patient comprised data from three periods of time: at the moment of glaucoma diagnosis and the results acquired in January 2010 and in January-May 2015.

    Results. During the follow-up period the IOP level decreased on treatment from 28 (25,00; 31,00) to 20 (17,00;22,00) mmHg (p<0,001;W=7,727). MD raised by on average -3,71 (-5,35; -2,28) dB in five years or more than 0.65 dB in a year that corresponds to a slowly progressive form of glaucoma. Median IOP-level was 20,00 (17,50;21,00) mmHg in patients with glaucoma progression less than 1 dB/year and 20,50 (19,00;21,00) mmHg in patients with glaucoma progression more than 1 dB/year (p>0,05). Patients with visual field change more than 5 dB in five years also had a greater interquartile range of IOP than patients with a milder disease progression (2,75 and 2,25 mmHg respectively, p=0,354; U=0,927).

    The analysis of correlation between visual field change and absolute IOP values fixed in clinical guidelines (19; 20 and 21) did not find any difference in all cases (p>0,05) thus all the IOP values could be recommended in current treatment algorithms. Those patients that had had well documented glaucoma anamnesis of 2,5 years on average five years before significantly more often used betablockers, underwent argon-laser trabeculoplasty and non-penetrating deep sclerotomy from 2010 to 2015; those patients that had had glaucoma anamnesis of 1,5 years by January 2010 most often used prostaglandin analogues.

    Conclusion. The results of the study could be used for clinical guidelines in order to determine the safe IOP range and choose the optimal treatment modality in patients with advanced glaucoma changes.

    Key-words: glaucoma, intraocular pressure level, static automatic perimetry, treatment modality; cluster analysis