Spectacle correction in the complex of therapeutic measures for primary angle closure glaucoma. Preliminary report

Abstract

PURPOSE. To improve the effectiveness of primary angle closure glaucoma (PACG) treatment in the initial stage in patients with hyperopia.MATERIAL AND METHODS. The study observed 18 patients (36 eyes) with the initial stage of PACG who also had low (8 subjects, 16 eyes) or moderate (10 subjects, 20 eyes) hyperopia. Study patients were divided into two groups: the main group — 12 patients (24 eyes) aged 43–67 years (mean age 55.6±1.1 years); the control group — 6 patients (12 eyes) aged 48–60 years (mean age 56.4±2.4 years). Prescribed treatment in the main group: selection and application of universal progressive correction, then laser iridecotomy (LIE) and management without pilocarpine instillations. Prescribed treatment in the control group: selection and application of monofocal correction for near vision, then LIE and instillations of 1% pilocarpine solution 3 times a day. All patients underwent visometry with correction, refractometry, ophthalmoscopy, tonometry, tonography, gonio-scopy, optical coherence tomography of the anterior eye segment, ultrasound biometry. Indicators of hydrodynamics and parameters of the anterior chamber were recorded before using spectacles correction, after the start of correction, after LIE, and 1 month after the start of all therapeutic measures.RESULTS. The use of progressive spectacle correction led to a significant decrease of true intraocular pressure (IOP) (p<0.001), an improvement of aqueous humor outflow (p<0.05) and an increase in the size of anterior chamber angle (p<0.001). Performing LIE in patients of the main group did not significantly change these indicators. The results obtained in this group made it possible to abandon the use of pilocarpine. In patients of the control group, the improvement in aqueous humor outflow (p<0.001) and increase in the size of anterior chamber angle (p<0.002) were more significant after LIE than after prescription of adequate monofocal correction for near vision (p<0.02–0.05 and p<0.2, respectively).CONCLUSION. The use of progressive spectacle correction in patients with hyperopia and initial stage of PACG before LIE leads to normalization of hydrodynamic parameters and an increase in the magnitude of anterior chamber angle without the use of miotic drugs. Prescription of progressive spectacle correction is advisable in these patients as a part of the complex of therapeutic measures aimed at normalizing ocular hydrodynamics.