PROGNOSIS OF POSTOPERATIVE PROGRESSION OF GLAUCOMA OPTIC NEUROPATHY AT PRIMARY OPEN-ANGLE GLAUCOMA

Anton Serdiuk

doi:10.21303/2504-5679.2020.001476

Abstract

Search for new informative markers and methods of prognosis prediction glaucomatous optic neuropathy (GON) in primary open-angle glaucoma (POAG) is an urgent task. We have established efficiency surgical treatment of POAG, but the progression of GON is observed in 10–15 % patients. It is known that the main mechanism of GON is apoptotic death retinal ganglion cells, a marker of which is recognized as tumour necrosis factor-α (TNFα), Fas-ligand (FasL) and a soluble form of the Fas-receptor (sFas/APO-1). The aim of the study: to find out the possibility of using apoptosis factors (TNFα, FasL and sFas/APO-1) to predict postoperative progression of GON at POAG. Methods. 69 patients (69 eyes) with POAG stage I–III were examined, who underwent trabeculectomy with implantation of an Ex-Press shunt. In intraocular fluid (IOF) markers of apoptosis was determined by the method enzyme-linked immunosorbent assay. Repeated ophthalmological examination was performed in 1 year. The control group consisted of 25 patients who were operated on about phacoemulsification of cataracts. For statistical and regression analysis used software package GLZ (Statistica 10, StatSoft, Inc. USA) and module of analysis of operational characteristics of regression models – ROC-diagrams (MedCalc 18.9.1, MedCalc Software, Belgium). Results. Multivariate regression analysis showed that the progression of GON determine the content in IOF of TNFα and sFas/Apo-1 before surgery and intraocular pressure after three months. Based on these indicators, it is calculated satisfactory model of GON progression prediction with 95.4 % accuracy. One-factor logistic regression analysis proved the influence of the content of TNFα, FasL and sFas/Apo-1 for the presence or absence of progression of GON during the year after operations: direct dependence took place for TNFα and FasL and inverse – for sFas/Apo-1. The critical limits of the content in the IOF markers are calculated apoptosis, in which the progression of GON is unmistakably predicted during year after surgery. Conclusions. The obtained results prove the significant influence of the studied markers apoptosis on the progression of GON after surgery. Direct pathogenetic influence belongs to TNFα and FasL.

Highlights

In Ukraine, as in other countries, primary open-angle glaucoma (POAG) is one of the priority problems of ophthalmology due to its large medical and social significance [1, 2]
Our previous research has established the effectiveness of the use of trabeculectomy (TE) for the surgical treatment of POAG with implantation of the Ex-Press shunt [9], which coincides with the data of the latter meta-analysis [10]
The aim of the study is to determine the possibility of using factors apoptosis (TNFα, FasL and sFas/APO-1) for the prognosis of postoperative progression of glaucoma optic neuropathy (GON) in POAG

Summary

Introduction

In Ukraine, as in other countries, primary open-angle glaucoma (POAG) is one of the priority problems of ophthalmology due to its large medical and social significance [1, 2]. The issues remain relevant timely diagnosis of glaucoma, determination of the rate of progression diseases and improvement of surgical treatment methods [5, 6]. The search for new informative markers and forecasting methods progression of glaucoma optic neuropathy (GON) is relevant today problem [7, 8]. Despite numerous studies of POAG, the mechanisms of development diseases continue to be studied because the pathogenesis is not yet final clarified [5, 7, 8]. The main links in the pathogenesis of POAG, in addition to violations outflow of aqueous humor and ischemic damage to the optic disc is development of GON and atrophy of retinal ganglion cells [11, 12]

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