[Initial combination therapy for primary open-angle glaucoma]. / 'Startovaia' kombinirovannaia terapiia pervichnoi otkrytougol'noi glaukomy.

PURPOSE: To study the efficacy and safety of initial combination therapy in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study included 111 patients (161 eyes) with stages II-III b-c of POAG aged 46 to 89 years (mean age 70.8±8.5 years). In the test group, therapy began with a fixed combination of prostaglandin (PG) (latanoprost) and beta-blocker (BB) (timolol). In patients of the control group, POAG therapy began with administration of the analogue of prostaglandin (latanoprost). When the target IOP was not achieved, a second drug was added to the treatment - instillations of 0.5% solution of timolol maleate 2 times a day. RESULTS: In patients of the test group the treatment started with a combination of BB + PG, the target IOP in the 'worst' eyes was achieved in 33 cases (64%) in 1.5±0.6 visits, and in the 'best' eyes - in 17 cases (81%), in 1.2±0.4 visits. In the control group with a 'step-by-step' selection of antihypertensive therapy, the target IOP in the 'worst' eyes was achieved in 35 cases (59%), in 2.5±0.7 visits, and in the 'best' eyes - in 22 cases (76%), in 2.2±0.5 visits (p<0.05). In both study groups, there were no cases of drug withdrawal attributed to their side effects. Patients noted conjunctival hyperemia in 5% (4 eyes) and 7% (6 eyes) of cases in the test group and the control group, respectively (p>0.05). Hyperemia decreased significantly in 2 weeks of latanoprost administration or fixed combination and did not cause withdrawal. CONCLUSION: Initial combination therapy is possible in patients with newly diagnosed POAG in some clinical situations, namely in stages II-III POAG with high IOP, unavailability of regular observation of patients for various social and economic reasons, absence of somatic and local contraindications to individual components of the combined treatment, etc.

[Reasons for intraocular pressure to resist hypotensive therapy in glaucoma patients]. / Prichiny rezistentnosti VGD k gipotenzivnoi terapii u bol'nykh s glaukomoi.

AIM: To study the reasons of intraocular pressure (IOP) resistance to therapy in patients with glaucoma. MATERIAL AND METHODS: During the period 2011-2013 we examined 72 primary glaucoma patients (stage I-III), 44 women and 28 men, aged 49-87 years (65.2±2.5 years on average) referred by local ophthalmologists due to poor response to hypotensive therapy. RESULTS: We suggest that glaucoma should be regarded as resistant if, despite combination therapy with three antihypertensive drugs at optimal doses, IOP stays above the target. In the present study, the treatment was found suboptimal in 19.4% of cases. About 45% of all patients (33 patients) demonstrated poor compliance to the prescribed treatment. Resistant glaucoma, as we have defined it, was diagnosed in 33% of cases (pigmentary glaucoma, pseudoexfoliation glaucoma, secondary unrecognized glaucoma, etc.). This group also included patients, in whom b-blockers were initially effective, but then seemed to lose their power. CONCLUSION: 1. The reasons for intraocular pressure to resist hypotensive therapy are often associated with medical inertia (inaccurate diagnosis, inadequate treatment, etc.) and lack of patient compliance. 2. Resistant glaucoma in its true sense accounts for about 35% of cases of IOP being above the target despite conservative treatment. 3. It is advisable that at the time of first presentation, any patient who fails to reach the target IOP is treated as an «uncontrolled glaucoma¼ case, until the reasons for his/her resistance are clear.

[Life expectancy of patients with primary glaucoma, residents of a large industrial city of Siberia].

PURPOSE: To investigate life expectancy and the structure of causes of death in patients with primary glaucoma, residents of a large industrial city of Siberia. MATERIAL AND METHODS: The database of the Novokuznetsk Public Health Department information analysis center on registration forms 025 (outpatients) and 066 (inpatients) for 2004-2011 was analyzed. RESULTS: A total of 5424 primary glaucoma patients were registered during 2004-2011, of whom 441 (8.1%) subsequently died. Age at death of patients with primary glaucoma was 69.0 +/- 7.2 years. The difference between age at death and at diagnosis of glaucoma was 2.6 +/- 1.8 years. CONCLUSION: The correlation suggests that primary glaucoma is a predicting factor for vascular events, such as stroke or myocardial infarction. The authors assume that topical administration of beta blockers without consulting a physician and/or a cardiologist may lead to ischemic stroke.

[Regarding the method of the total tear production assessment].

Different Schirmer test I techniques presented in the literature have been reviewed and a comparative study of Schirmer test I results obtained with the eyes opened and closed has been conducted. The total tear production with the eyes opened vs. closed averaged 17.1+/-1.1 mm and 12-1.2 correspondingly (p=0.001; Mann-Whitney U test). In 22% of patients values were higher with the eyes closed rather than opened. The authors recommend to specify the conditions of the performed test when entering the results into the patient's chart.

[Study on causes of ophthalmologists' inertia in glaucoma treatment].

The problem of inertia in ophthalmological practice, which implies the absence of any adjustment of the given treatment, even if an adjustment is objectively necessary or clinically indicated, was studied. According to the authors, the problem is most pressing when multifactorial diseases, including primary glaucoma, are concerned. An anonymous survey of 147 ophthalmologists from different West Siberian regions (Altai Krai, Kemerovo region, and Republic of Khakassia) was conducted. The set of causes for ophthalmologists' inertia was identified. The leading cause appeared to be psychological reluctance to achieve target intraocular pressure and overestimation of therapeutic success. Other causes, although less significant, include lack of professional awareness and economic barriers to decision making.