Choice regularities of antihypertensive therapy regimens of primary open-angle glaucoma in conditions of real clinical practice

Z.M. Nagornova1, A.V. Seleznev1, P.Ch. Zavadsky2, A.V. Kuroyedov3,4 1 Ivanovo State Medical Academy, Russian Federation 2 High-tech Cataract Treatment Center «New Vision», Minsk, Republic of Belarus 3 Central Military Clinical Hospital named after P.V. Mandryka, Moscow, Russian Federation 4 Pirogov Russian National Research Medical University, Moscow, Russian Federation Aim: to study effectiveness of different regimens of primary open-angle glaucoma (POAG) therapy, choice and change algorithms of ophthalmic treatment components in conditions of real clinical practice. Patients and Methods: results of 398 patients (641 eyes) with different stages of POAG, diagnosed at least 6 months ago, were included in this study. At the time of enrollment in the study, a stage of the disease was verified according to current classification of glaucoma with intraocular pressure (IOP) measurement, analysis of morphometric and functional indices. Results: a mean level of IOP (all stages of the disease) at the time of glaucoma diagnosis was 28.00 (26.00; 30.00) mm Hg. It was established that a number of patients with IOP compensation is inversely proportional to a stage of the disease. All patients with the glaucoma (641 eyes) had 44 different regimens (therapy, lasers, surgery). IOP levels were analyzed in the patients with different stages of POAG who received these different regimens of therapy. Those patients in whom an advanced stage of the disease was diagnosed had significantly higher IOP at the time of diagnosis than patients with a second and first stage of the disease. An analysis of dependence of therapy regimen content on glaucoma history duration in the different stages of POAG was carried out, and the most “popular” regimens used were established. Conclusion: IOP level at the time of POAG diagnostics can determine a stage of the disease and serve as a prognostic sign of a disease course. To achieve a target IOP is possible at an early stage of the glaucoma in 95.86% of cases, at a moderate and advanced — in 74.14% and 35.95% of cases, respectively. There is a tendency to be chosen as a starting regimen for the early glaucoma of monotherapy with beta-blockers, while prostaglandin analogues are prescribed for duration of the disease for more than a year. With higher-level stages of the glaucoma, combinations of drugs and penetrating glaucoma surgery prevail. Key words: glaucoma, intraocular pressure, beta-adrenoblockers, prostaglandin analogues, combination therapy, therapy regimens. For citation: Nagornova Z.M., Seleznev A.V., Zavadsky P.Ch., Kuroyedov A.V. Choice regularities of antihypertensive therapy regimens of primary open-angle glaucoma in conditions of real clinical practice. RMJ “Clinical ophthalmology”. 2018;3:116–123.<br

Glaucoma &quot;landscape&quot; in Russia, CIS and Eastern European countries: what has changed over 15 years?

A.Yu. Brezhnev1, E.A. Egorov2, V.P. Erichev3, A.V. Kuroedov2,4, P.Ch. Zavadsky5, M. Bozic6, N.N. Voronova7, M.F. Dzhumova8, N.V. Ivanova7, T.A. Imshenetskaya9, T.G. Kamenskikh10, O.I. Lebedev11, L.N. Marchenko8, A.L. Onishchenko12, N.A. Sobyanin13, V.F. Ekgardt14 1Kursk State Medical University, Kursk, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation 3Krasnov Research Institute of Eye Diseases, Moscow, Russian Federation 4P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 5LLC "Ophthalmological Center of Karelia", Petrozavodsk, Russian Federation 6University Eye Clinic, University of Belgrade, Belgrade, Serbia 7V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation 8Belarusian State Medical University, Minsk, Belarus 9Belarusian Medical Academy of Post-Diploma Education, Minsk, Belarus 10V.I. Razumovskiy Saratov State Medical University, Saratov, Russian Federation 11Omsk State Medical University, Omsk, Russian Federation 12Novokuznetsk State Institute for Advanced medical Education — Branch of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russian Federation 13F.Kh. Gral City Clinical Hospital No. 2, Perm, Russian Federation 14South Ural State Medical University, Chelyabinsk, Russian Federation Aim: to assess the changes in clinical and epidemiological characteristics, diagnostic and treatment options of primary open-angle glaucoma (POAG) in the Russian Federation and multiple near- and far-abroad countries over the period of 2005–2020. Patients and Methods: the final protocol of this retrospective multi-center research and clinical study included 289 patients with POAG from 7 states (Russia, Belarus, Serbia, Moldova, Kyrgyzstan, Slovakia, and Slovenia). The authors analyzed the methods used for establishing POAP diagnosis, clinical and demographic patient characteristics (gender, age and place of residence), as well as the process of glaucoma development (age of onset, disease duration and stages, intraocular pressure, ocular hypotensive medications, and the used laser and surgical procedures). All patients were divided into four groups depending on the time of making the initial diagnosis: 2004–2005, 2009–2010, 2014–2015, 2019–2020. Results: tonometry with Maklakov and Goldmann tonometers is still considered the gold standard for measuring intraocular pressure (IOP) (95% of cases). The percentage of pneumotonometry increased from 40% in 2005 to 60% in 2020. Approximately a third of clinics are still using electronic tonography as a supplementary method. Static automated perimetry is a basic tool for diagnosis and follow-up of patients with POAG (more than 95% of cases). Manual kinetic perimetry (Foerster's perimetry) is used in less than 10% of cases. Ophthalmoscopy (direct and binocular) was involved in the diagnostic process in all clinics and in all cases. The range of instrumental visualization technologies includes optical coherence tomography (OCT), Heidelberg Retina Tomography (HRT), and scanning laser polarimetry. Currently, OCT is utilized in 90% of clinics. It was found out that in 2005 the standard of initial POAG diagnosis encompassed a set of Maklakov/Goldmann tonometry, ophthalmoscopy and kinetic perimetry. In 2020, this list includes Maklakov/Goldmann tonometry, pneumotonometry as a supplemental tool, static automated perimetry, ophthalmoscopy and OCT. The percentage of newly diagnosed POAG at the early stage has increased twofold over the past 15 years (from 20% in 2005 to 38% in 2020). The mean age of patients at the time of initial POAG diagnosis in 2005 was 62 (52; 67) years, in 2020 — 65 (50; 70) years, respectively (р=0.694). The proportion of prostaglandins in medication therapy increased by 20% over the past 15 years, while the proportion of beta-blockers reduced by the same percentage. The use of cholinomimetic drugs was almost discontinued. The total number of glaucoma laser surgeries has grown, and in the last decade the top priority has been given to selective laser trabeculoplasty, while the share of argon laser trabeculoplasty has decreased by 10%. The rate of primary glaucoma surgeries (trabeculectomy) keeps going down. Conclusion: a gradual and consistent implementation of high-tech diagnostic methods (static automated perimetry and OCT) in the routine practice occurred over 2005–2020. Also, there was a clear trend in more extensive use of objective data. The evolution of pharmaceutical "landscape" in the disease management is associated with an increasing proportion of more effective and safe drugs (prostaglandin analogues) and a diminishing role of beta-blockers as drugs of choice for starting therapy. The share of glaucoma surgeries as a starting strategy of POAG management was running down steadily from 2005 to 2010. Keywords: glaucoma, intraocular pressure, tonometry, perimetry, optical coherence tomography, trabeculectomy. For citation: Brezhnev A.Yu., Egorov E.A., Erichev V.P. et al. Glaucoma "landscape" in Russia, CIS and Eastern European countries: what has changed over 15 years? Russian Journal of Clinical Ophthalmology. 2023;23(2):73–79 (in Russ.). DOI: 10.32364/2311-7729-2023-23-2-73-79.&nbsp; </p

Risk factors affecting progression and course of primary open-angle glaucoma in patients with different disease stages (multicenter study)

N.E. Fomin1,2, P.Ch. Zavadskiy3, A.V. Kuroedov1,2, A.V. Seleznev4, Z.M. Nagornova4, D.A. Baryshnikova5, R.V. Avdeev6, A.M. Getmanova7, I.A. Glushnev8, A.A. Gusarevich9, D.A. Dorofeev10, S.V. Kosmynina11, O.S. Myakonkaya12, N.A. Rebenok8, Yu.I. Razhko8, I.I. Semenova13, T.V. Chernyakova14 1P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation 3 Karelia Ophthalmological Center, Petrozavodsk, Russian Federation 4Ivanovo State Medical Academy, Ivanovo, Russian Federation 5Sectoral Clinical Diagnostic Center of the PJSC "Gazprom", Moscow, Russian Federation 6 N.N. Burdenko Voronezh State Medical University, Voronezh, Russian Federation 7 Bryansk Regional Hospital No. 1, Bryansk, Russian Federation 8Republican Scientific Practical Center of Radiation Medicine and Human Ecology, &nbsp; Gomel, Republic of Belarus 9 Clinical Hospital "RZD-Medicine" of the city of Novosibirsk, Novosibirsk, Russian Federation 10 City Clinical Hospital No. 2, Chelyabinsk, Russian Federation 11 P.A. Bayandin Murmansk Regional Clinical Hospital, Murmansk, Russian Federation 12Volgograd Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, &nbsp; Volgograd, Russian Federation 13 Mogilev City Hospital of the Emergency Medical Care, Mogilev, Republic of Belarus 14 Multidisciplinary Medical Center of the Bank of Russia, Moscow, Russian Federation Aim: to identify certain risk factors and their associations, which&nbsp;determine the prognosis of primary open-angle glaucoma (POAG) in patients with different disease stages. Patients and Methods: the final protocol of this clinical research combines multicenter study included the results of dynamic follow-up of 293 patients (293 eyes) with different stages of POAG. The mean age at the time of diagnosis was 65 (59; 70) years. The duration of verified POAG history was 3 (1; 6) years. Age, medical history, disease stage, IOP levels, IOP-lowering medications, comorbidities, other (social) factors (in total, 23 entities considered potential causes of refractory glaucoma) were investigated. All participants were divided into two groups (non-refractory glaucoma and refractory glaucoma) that included six&nbsp;subgroups according to current guidelines on achieving target IOP in various treatment approaches. Results: at the time of verified diagnosis and final examination of POAG patients, IOP levels were higher in the refractory glaucoma group and patients with advanced glaucoma (p&lt;0.001). The most common risk factors, comorbidities, and other variables characterizing refractory glaucoma were pseudoexfoliative syndrome/PEX (53.5%), pigment dispersion syndrome/PDS (16.7%), dry eye disease/DED (38.6%), high myopia (7.9%), coronary heart disease/CHD (40.3%), smoking (16%), and disability resulting from a general illness (12.6%). The rate of these entities varied from 11.1% to 69.4%, being most common in the refractory glaucoma group. Refractory glaucoma patients had a tendency&nbsp;to a slow return to topical treatment in the early postoperative period after glaucoma surgery, despite the lack of achieving target IOP. Conclusion: our study has demonstrated that IOP levels at the time of verified diagnosis directly correlate with the stage of newly diagnosed glaucoma and IOP levels in the setting of glaucoma treatment and predetermine&nbsp;future refractory disease. Moreover, PEX, PDS, DED, CHD, prior myocardial infarction, and disability resulting from a general illness are additional factors determining POAG resistance to treatment. Keywords: glaucoma, intraocular pressure, refractory, risk factors, progression. For citation: Fomin N.E., Zavadskiy P.Ch., Kuroedov A.V. et al. Risk factors affecting progression and course of primary open-angle glaucoma in patients with different disease stages (multicenter study). Russian Journal of Clinical Ophthalmology. 2022;22(2):80–90 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-80-90. <br