Preservative free travoprost and timolol fixed combination in the initial treatment of primary glaucoma: an assessment of hypotensive efficiency and safety

Purpose. To evaluate the efficacy and safety of Travapress Duo with respect to hypotensive results, changes in functional parameters, and adverse reactions. Material and methods. 30 patients aged 65–75 (averagely 71.3 ± 3.2 years) with a newly diagnosed primary open-angle glaucoma (POAG) received Travapress Duo in the evening, once a day. Goldman tonometry was performed during the screening, then 1 week, 1 month and 3 months from the treatment start. Static perimetry and optical coherence tomography (OCT) were performed before treatment and at the end of the 3rd month since the treatment start. Adverse events were recorded at each stage of the study.Results. As a result of a 3 month long therapy with Travapress Duo, a significant decrease in IOP was noted starting from the 1st week of instillations (by 34 %), after 1 month, by 35 % and after 3 months of observation by 36 %. By the end of the 3rd month of treatment, we noted an insignificant increase in visual acuity, a positive dynamic of the standard deviation and the standard deviation pattern, as well as OCT indicators, such as average thickness of the layer of retinal nerve fibers and the layer of retinal ganglion cells in the macula, stabilization of the thickness of the retinal ganglion cell complex layer and the size of the inner plexiform layer. One patient complained of discomfort and hyperemia by the end of the 1st week of drug instillation. No systemic side effects were noted during the follow-up, and in no case drug withdrawal was require. Conclusion. The preservative-free Travapress Duo drug displayed a high hypotensive efficacy, reducing the IOP to 36% of the initial value. The hypotensive effect was accompanied by indirect neuroprotection, which manifested itself in the positive changes observable in the results of functional studies with varying degrees of reliability. Travapress Duo is characterized by a low level of local side effects and can be recommended for both for the initial and long-term therapy of primary glaucoma of developed and advanced stages.

A personalized approach to preclinical diagnosis and initial therapy of primary glaucoma based on a comprehensive structural and functional examination. A clinical case

The principles of personalized approach to early diagnosis and monitoring of primary glaucoma are shown by a clinical example. We analyzed the potentials of contemporary electrophysiological tests for preclinically diagnosing glaucoma optic neuropathy and monitoring drug treatment. For the first time, we demonstrated the experience of using a new fixed combination of brinzolamide + brimonidine by a clinical case from our practice. The test results confirm the hypotensive effect of the medication (IOP reduction by 36.2 %) so that it can be recommended for the treatment of patients with glaucomatous optic neuropathy and that combined with vascular pathology.

The Assessment of Morphological and Functional Changes in the Detection of the Initial Stage of Primary Glaucoma

Purpose — to study morphological and functional changes in the detection of primary glaucoma progression.Patients and methods. 128 patients (128 eyes, among them — 64 eyes with primary open angle glaucoma (POAG) and 64 with primary angle closure glaucoma (PACG)) with the initial MD of –6.0 dB were examined at the Ophthalmology Center of the FMBA of Russia from May 2016 to November 2019. The values of corneal-compensated IOP were also considered: minimal (IOPmin), peak (IOPmax) and its fluctuations (IOPfluct). The progression was measured using standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). During the observation period, each patient received the average of 8.42 ± 2.08 SAP and SD-OCT. Progressive thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated using SD-OCT. If RNFL and/or GCC had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The correlation between the rate of progression detected by SAP (ROP1) using thinning of RNFL (ROP2) and GCC (ROP3) with other clinical parameters was analyzed.Results and discussion. Glaucoma progression was detected in 73 eyes. While the isolated use of SAP did not allow detecting progression, it was possible to detect it in 39 % cases by SD-OCT. The combination of both methods allowed detecting progression in 57 %. In both forms, ROP1 correlated with IOPmin: in PACG r = 0.41, p = 0.023 and in POAG r = 0.43, p = 0.016. In PACG, ROP2 and ROP3 correlated with the foveal choroid thickness: r = 0.46, p = 0.019 and r = 0.47, p = 0.009, respectively. At the same time, ROP3 was associated with peak IOP (r = –0.402, p = 0.025); the correlation of peak IOP with its fluctuations amounted to 0.7 (p < 0.001).Conclusion. SD-OCT is more informative than SAP in determining the progression of the initial primary glaucoma. The combination of these two methods 1.5 times increases the possibility of detecting progression in comparison with the isolated use of SD-OCT. The choroid thickness, associated with the IOP fluctuations, plays an important role in the progression of PACG.

PROGNOSTICALITY OF CARDIOVASCULAR FACTORS IN THE DEVELOPMENT OF GLAUCOMA IN THE ELDERLY

Развитие первичной открытоугольной глаукомы определяется множеством факторов риска, в том числе сердечно-сосудистыми, изучение которых выполняется крайне редко. Цель исследования - определение прогностической значимости системных сердечно-сосудистых факторов риска в развитии первичной открытоугольной глаукомы у пожилых людей. В клинических условиях проведено комплексное офтальмологическое обследование 250 пациентов 45-59 лет с первичной глаукомой, 260 пациентов 60-74 лет без первичной глаукомы, 280 пациентов 60-74 лет с первичной глаукомой. По единой методике проведено изучение в трёх вышеуказанных клинических группах сердечно-сосудистых факторов риска с определением прогностической значимости с учётом общепринятых требований. Установлена высокая распространённость среди факторов риска первичной открытоугольной глаукомы артериальной гипертензии, ишемической болезни сердца и атеросклероза сонных артерий. У пациентов основной группы в возрасте 60-74 лет, представленных больными первичной открытоугольной глаукомой, артериальная гипертензия, по данным анамнеза и анализа медицинской документации, встречается наиболее часто - в 78,6±2,5 на 100 обследованных, что значительно выше по сравнению с возрастным контролем, то есть пациентами 60-74 лет без вышеуказанной нозологии офтальмопатологии, где она зарегистрирована у существенно меньшей части - в 55,8±3,1 случаев на 100 обследованных со статистически значимым различием. Артериальная гипертензия реже по сравнению с пациентами с первичной открытоугольной глаукомой диагностируется в среднем возрасте пациентов с первичной открытоугольной глаукомой - в 44,8±3,1 случаев на 100 обследованных. Вторым наиболее часто встречающимся сердечно-сосудистым заболеванием, рассматриваемым нами в качестве сердечно-сосудистого фактора риска, является атеросклероз сонных артерий (внутренней и общей), который выявлен у 71,8±2,7 случаев на 100 обследованных. Это значительно выше, чем распространенность данной кардиоваскулярной патологии в пожилом возрасте, не имеющих первичной открытоугольной глаукомы. Однако распространенность атеросклероза у пациентов 45-59 лет с первичной открытоугольной глаукомой по сравнению с пациентами пожилого возраста без первичной открытоугольной глаукомы практически одинакова и не имеет статистически значимых различий. Значительно часто у больных пожилого возраста распространена ишемическая болезнь сердца, достигающая 60,7±2,9 случаев на 100 обследованных, что практически в 2 раза выше, чем в двух других группах. Однако наибольшей прогностической значимостью в отношении развития первичной глаукомы в пожилом возрасте обладают хроническая сердечная недостаточность, инфаркт миокарда в анамнезе и ишемическая болезнь сердца, что необходимо использовать при индивидуальном прогнозировании The development of primary open-angle glaucoma (POAG) determined by a variety of risk factors, including cardiovascular ones, which are rarely studied. The aim of the study was to determine the prognostic significance of systemic cardiovascular risk factors in the development of POAG in the elderly. In clinical conditions, a comprehensive ophthalmological examination of 250 patients 45-59 years old with primary glaucoma, 260 patients 60-74 years old without primary glaucoma, 280 patients 60-74 years old with primary glaucoma performed. According to a single methodology, the study of cardiovascular risk factors in the three above-mentioned clinical groups carried out, with the determination of prognostic significance taking into account generally accepted requirements. The high prevalence of arterial hypertension, coronary heart disease and carotid artery atherosclerosis among the risk factors for POAG was established. However, chronic heart failure, a history of myocardial infarction, and coronary heart disease have the greatest prognostic significance for the development of primary glaucoma in the elderly, which be used for individual prognosis

The role of general medical examination of the population in the detection of glaucoma

Purpose. The aim of this study was to examine effectiveness of the General medical examination of the population in identifying patients with glaucoma. Material and methods. An analysis of 17593 medical records of patients older 40 years old who underwent a screening method for measuring intraocular pressure was performed for period 2016-2018. When an increased intraocular pressure was detected, an in-depth examination was carried out at the second stage. Results. An increase in intraocular pressure was found in 3.7% of the surveyed (642 people). The second stage of clinical examination showed that 298 people (1.7%) had signs of primary glaucoma (high and borderline values of intraocular pressure, changes in the field of vision). Further in-depth examination in a specialized glaucoma center revealed that 186 people had glaucoma, with 84% cases at the first stage. Conclusion. General medical examination revealed glaucoma at an early stage of the disease 1.1% of the surveyed. Key words: general medical examination, screening method, glaucoma.

Incidence of Primary Glaucoma in a Cohort of Nuclear Workers

Objective: The study was aimed to estimate primary glaucoma incidence in a cohort of nuclear workers occupationally exposed to ionizing radiation over prolonged periods.Materials and methods. The cohort considered in the study included workers of the Mayak Production Association. All glaucoma cases that were reported in the study worker cohort regardless of its type were identified using the medical and dosimetry database ‘Clinic’. Statistical analyses were performed to estimate non-standardized (crude) and standardized incidence rates for primary glaucoma. Standardization was carried out indirectly using age distribution for the whole cohort as an internal reference. Incidence rates were estimated per 1000 person-years in accordance with conventional medical statistics.Results. At the end of the follow-up period, 476 primary glaucoma cases were reported in the study worker cohort over 482,217 person-years of the follow-up. The standardized primary glaucoma incidence was estimated to be 1.00 ± 0.05 in males and 0.70 ± 0.07 in females. Crude primary glaucoma estimates in both males and females increased with the increasing attained age of the workers. Crude incidence rates in males were significantly higher than in females for age 50–69. The standardized primary glaucoma incidence in males was also significantly increased compared to females. The standardized primary glaucoma incidence rates were increasing throughout the period from 1960s to the end of the follow-up.

The role of general medical examination of the population in the detection of glaucoma

Purpose. The aim of this study was to examine effectiveness of the General medical examination of the population in identifying patients with glaucoma. Material and methods. An analysis of 17593 medical records of patients older 40 years old who underwent a screening method for measuring intraocular pressure was performed for period 2016-2018. When an increased intraocular pressure was detected, an in-depth examination was carried out at the second stage. Results. An increase in intraocular pressure was found in 3.7% of the surveyed (642 people). The second stage of clinical examination showed that 298 people (1.7%) had signs of primary glaucoma (high and borderline values of intraocular pressure, changes in the field of vision). Further in-depth examination in a specialized glaucoma center revealed that 186 people had glaucoma, with 84% cases at the first stage. Thus, general medical examination revealed glaucoma at an early stage of the disease 1.1% of the surveyed. Key words: general medical examination, screening method, glaucoma.

Epidemiological features of glaucoma prevalence among the population of the Russian Federation

PURPOSE. To study the epidemiological features of glaucoma prevalence among the population of the Russian Federation and to assess the organization of primary specialized medical care for patients with this pathology.MATERIALS AND METHODS. The subject of this study was the population of the Russian Federation diagnosed with glaucoma. In order to assess the epidemiological features of glaucoma prevalence and to assess the organization of primary specialized medical care for patients with this pathology, according to the federal statistical reporting forms (Forms No. 12, No. 30), the following indicators were calculated: overall and primary incidence of glaucoma in the general population; proportion of patients with glaucoma who are registered with ophthalmologists; availability of ophthalmologists (individuals) per 100 thousand population; proportion of patients with glaucoma diagnosis established during preventive examinations; total number of registered patients with blindness and visual impairment. Statistical processing of the material involved methods of descriptive statistics; calculation of average and relative values with a preliminary assessment of the distribution of indicators for normality. Spearman rank correlation method was used to determine the correlation between quantitative variables.RESULTS. The studied data was used to calculate the following average values: total and primary glaucoma incidence among the population of the Russian Federation — 78.2 (55.8–105.3) cases per 100 thousand population; the proportion of patients with dispensary registered glaucoma — 80% (74.4–85.8%). The performed correlation analysis established a moderate direct statistically significant relationship between the indicators of total and primary glaucoma incidence among the population (rank correlation coefficient: r=0.72 at p<0.05). In its turn, the correlation between the indicators of glaucoma incidence among the population and the availability of ophthalmologists for the population has not been established (r=0.14, p>0.05). It was found that the indicators of dispensary observation of glaucoma patients do not depend on the indicators of total glaucoma incidence (r=0.16) and availability of ophthalmologists for the population (r=0.13). There is a weak inverse correlation between the proportion of glaucoma cases detected during preventive examinations and the indicator of primary glaucoma incidence among the population (r=-0.28; p<0.05). Also, the correlation analysis did not establish a relationship between the indicator of total glaucoma incidence among the population and the total number of registered patients with blindness and low vision (r=-0.008).CONCLUSION. The incidence rate of glaucoma in specific administrative territories should be assessed by comparison with the average values among the whole population, which are represented by the median and quarterly ranges. The incidence rate of glaucoma in the general population is not statistically related to the level of availability of ophthalmologists for the population. The proportion of follow-up observation of glaucoma patients does not depend on the availability of ophthalmologists and the level of glaucoma incidence. The incidence of blindness and low vision does not statistically correlate with the incidence of glaucoma in the population.