Algorithm of the Rehabilitation of Patients with Pigmentary Glaucoma

Abstract

Background. Irreversible changes in corneoscleral trabecula lead to persistent hydrodynamic disturbances not only in pigmentary glaucoma but also in pigmentary dispersion syndrome. In these cases isolated laser iridectomy cannot compensate ophthalmotonus and stabilize pathologic process.Aim: to evaluate effectiveness of treatment and rehabilitation algorithms for patients with pigmentary glaucoma, depending on irido-ciliary zone state and IOP level.Materials and methods. 12 people with pigmentary dispersion syndrome in manifestation stage and 20 people with pigmentary glaucoma were examined.Results. In pigmentary glaucoma, initial IOP level was 28.2 ± 3.79 mm Hg, coefficient of outflow easiness was 0.09 ± 0.03 (p < 0.001). In pigmentary dispersion syndrome at stage of manifestation, hydrodynamic shifts were latent with IOP of 19.03 ± 0.79 mm Hg: positive load test, reduced coefficient of outflow easiness 0.15 ± 0.07 (p < 0.001). Significant changes were found in nerve fiber layer, retinal ganglion complex and perimetric indices in both groups, but they were irreversible in patients with pigmentary glaucoma. Laser iridectomy was performed in 100 % of cases in pigmentary dispersion syndrome and in 75 % of cases in pigmentary glaucoma. Local medication therapy was prescribed in 100 % of cases for IOL decrease in manifestation stage of pigmentary dispersion syndrome, and in pigment glaucoma it was effective in 34 %. In remaining cases fistulizing operations were performed initially.Conclusion. The algorithm of the rehabilitation of patients with pigmentary dispersion syndrome in stage of manifestation and with pigmentary glaucoma has character of not preventive, but therapeutic measures, including not only laser iridectomy, but also a hypotensive regimen in 100 % of cases. In pigmentary glaucoma, fistulizing operation can be considered as a starting hypotensive option.