New concept of etiopathogenesis and treatment of primary open-angle glaucoma

Abstract

Primary open-angle glaucoma (POAG) is one of the main causes of irreversible blindness. There is no single theory of POAG development. The trigger of the disease is unknown. Treatment is ineffective. The author's concept: the trigger of the glaucomatous process is a genetically programmed small distance between the ciliary body and the lens equator (less than the age-related norm) in the presbyopic period of life. This causes weakness of accommodation and triggers further pathological changes in the eye. For proof of concept, large-scale studies of the anterior segment of the eye (ultrasound biomicroscopy) should be performed in presbyopes with ophthalmic hypertension, with and without POAG, with measurement of the distance "ciliary body - lens equator". Objective acomodometry is also necessary to determine the volume of accommodation in the above patients. In case of confirmation of the author's concept, a 3-component phased treatment of POAG is proposed: 1. Surgical expansion of the ciliary body ring (scleral thinning) - non-penetrating supraciliary sclerectomy or application of antimetabolites to the supraciliary sclera; 2. Phaco emulsification of the lens with implantation of an IOL model that maximizes the volume of pseudo - accommodation; 3. antiglaucomatous microinvasive surgery.