Treatment Of Primary Open-angle Glaucoma Research Articles

Trabeculectomy Versus EX-PRESS Shunt Versus Ahmed Valve Implant: Short-term Effects on Corneal Endothelial Cells

To evaluate short-term changes in corneal endothelial cells after trabeculectomy, EX-PRESS device implantation, and Ahmed valve implantation for the treatment of primary open-angle glaucoma. Prospective, interventional, comparative case series with contralateral eye control study. We prospectively evaluated the changes in number, density, and shape of the corneal endothelium cells in 128 eyes of 64 patients divided into 3 groups depending on the treatment received. Corneal specular microscopy was performed with a noncontact specular microscope preoperatively and at 1 and 3months after surgery. The changes at each time point were compared with those of the control group, which consisted of 32 contralateral glaucomatous eyes receiving antiglaucoma medications without any previous glaucoma surgery. In the subjects who underwent trabeculectomy, corneal endothelial cell density (ECD) significantly decreased by 3.5% (P= .012, paired t test) at 1month and 4.2% (P= .007) at 3months after surgery, compared to the baseline values. In the Ahmed valve group ECD did not change at 1month after surgery and had a significant 3.5% decrease at 3months (P= .04). In the patients who underwent EX-PRESS implantation and in the control group ECD did not change either at 1month or at 3months after surgery (P > .05). EX-PRESS shunt, compared to trabeculectomy and Ahmed valve, seems to be a safer procedure regarding the risk of endothelial cell loss. For this reason, it may be the treatment of choice in patients with significant low corneal ECD before surgery or other risk factors forcorneal damage.

Design, Analysis, and Reporting of Crossover Trials for Inclusion in a Meta-Analysis.

Randomized crossover trials are clinical experiments in which participants are assigned randomly to a sequence of treatments and each participant serves as his/her own control in estimating treatment effect. We need a better understanding of the validity of their results to enable recommendations as to which crossover trials can be included in meta-analysis and for development of reporting guidelines.ObjectiveTo evaluate the characteristics of the design, analysis, and reporting of crossover trials for inclusion in a meta-analysis of treatment for primary open-angle glaucoma and to provide empirical evidence to inform the development of tools to assess the validity of the results from crossover trials and reporting guidelines.MethodsWe searched MEDLINE, EMBASE, and Cochrane’s CENTRAL register for randomized crossover trials for a systematic review and network meta-analysis we are conducting. Two individuals independently screened the search results for eligibility and abstracted data from each included report.ResultsWe identified 83 crossover trials eligible for inclusion. Issues affecting the risk of bias in crossover trials, such as carryover, period effects and missing data, were often ignored. Some trials failed to accommodate the within-individual differences in the analysis. For a large proportion of the trials, the authors tabulated the results as if they arose from a parallel design. Precision estimates properly accounting for the paired nature of the design were often unavailable from the study reports; consequently, to include trial findings in a meta-analysis would require further manipulation and assumptions.ConclusionsThe high proportion of poorly reported analyses and results has the potential to affect whether crossover data should or can be included in a meta-analysis. There is pressing need for reporting guidelines for crossover trials.

Fixed-combination treatments for intraocular hypertension in Chinese patients - focus on bimatoprost-timolol.

Glaucoma is a common eye disease that can lead to irreversible vision loss if left untreated. The early diagnosis and treatment of primary open-angle glaucoma is challenging, and visual impairment in Chinese glaucoma patients is a serious concern. Most of these patients need more than one topical antiglaucoma agent to control their intraocular pressures (IOPs). In the People’s Republic of China, the daily cost of different glaucoma medication varies greatly, and the treatment habits differ throughout the country. Prostaglandin analogs (PGAs) are recommended as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Fixed-combination drops, particularly PGA-based fixed combinations, have recently been developed and used in patients with progression or who have failed to achieve their target IOPs. Here, we reviewed the current literature on the use of bimatoprost-timolol fixed combination (BTFC) in the People’s Republic of China. BTFC has achieved good efficacy and tolerability in Chinese clinical trials. In addition, BTFC is more cost effective compared with other fixed combinations available in the People’s Republic of China. Fixed-combination drops may offer benefits, such as keeping the ocular surface healthy, convenience of administration, and improvement in long-term adherence and quality of life. Therefore, BTFC has great potential for the treatment of Chinese glaucoma patients. However, the long-term efficacy of BTFC, comparisons of BTFC with other fixed-combination drugs, and treatment adherence and persistence with treatment in Chinese patients are unknown and will require further study.

Assessment of Active Metabolites of Levobunolol and Betaxolol in Rat, Rabbit and Human Ocular and Liver S9 Fractions

Little is known about ocular metabolism and formation of pharmacologically active metabolites for drugs dosed topically to the eye. We devised a simple in vitro approach coupled with high resolution mass spectrometry to measure the rate and extent of ocular metabolism for comparison with liver. Levobunolol and betaxolol are antagonists of β‐adrenergic receptors and have been clinically utilized for treatment of primary open‐angle glaucoma and/or ocular hypertension. Levobunolol has been reported to be metabolized to an equipotent active metabolite, dihydrolevobunolol, in plasma and urine of mice, rat, dog, and human. Hydroxybetaxolol, an active metabolite of betaxolol, has been reported in the liver. We aimed to understand whether the eye has functional metabolic activity and to understand the extent of formation of two historically reported in vivo active metabolites, one each for levobunolol and betaxolol, across rat (R), rabbit (Rbt) and human (H) ocular S9 (OS9) fractions and liver S9 (LS9) fractions. Based on high resolution mass spectrometry M11 was identified as the active dihydroxylevobunolol while M2 was identified as the active hydroxybetaxolol. The in vitro data shows that betaxolol's M2 was formed in the eye across preclinical species and human. M2 pharmacological activity for antagonism toward β1‐ or β2‐receptors has not been assessed to date. This is the first report of hydroxybetaxolol being formed in the eye. Results from levobunolol and betaxolol metabolism studies point toward species differences in conversion of levobunolol and betaxolol to their respective active metabolites and strongly indicate that LS9 fractions are a poor surrogate for assessment of active metabolites formed in the eye.

A prospective randomized study of selective laser trabeculoplasty (SLT) as a replacement for medical therapy in primary open-angle glaucoma

To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) as a replacement for medical therapy in primary open-angle glaucoma (POAG). A prospective, randomized, controlled study.SLT treatment with SOLO SLT Nd: YAG laser was provided to 45 participants with advanced POAG (67 eyes, IOP ≤ 21 mmHg, 1 mmHg = 0.133 kPa) under anti-glaucomatous medications control). A table of random numbers was created by simple randomization method. Participants were randomly divided into two groups: the standard-energy group (34 eyes), which received a 270° standard-energy SLT treatment and the sub-threshold energy group (33 eyes), which received a 360° sub-threshold energy treatment. The intraocular pressure (IOP) before and after SLT, daytime IOP curve, dosage of anti-glaucoma drugs and treatment complications were observed, which were be followed up for 6-9 months (average 6.4 months). Two-tailed t-test or paired t test was used when the continuous variables were normal distribution, such as the basic data, daily fluctuations of IOP, laser energy. Non-parametric Mann-Whitney U test or Wilcoxon rank test was used when data was not distributed normally, such as drug category. Chi-square or Fisher's exact test was used when count variables such as success rate and complications were analyzed. The number of anti-glaucomatous drugs used in the standard-energy group and the sub-threshold energy group before SLT was (2.3 ± 0.5) and (2.1 ± 0.4), respectively; whereas, after the last treatment, it reduced to (1.3 ± 0.5) and (1.1 ± 0.3), respectively (Z = -5.477, -5.396; P < 0.05). The success rate of the standard-energy group and the sub-threshold energy group was 91.1%, and 87.9%, respectively, which was not significant different (P = 0.70). Laser treatment was found to reduce the IOP fluctuation during the daytime.IOP fluctuation decreased from (3.6 ± 1.0) mmHg to (2.3 ± 1.0) mmHg in the standard-energy group, and decreased from (3.9 ± 1.4) mmHg to (2.4 ± 0.9) mmHg in the sub-threshold energy group, which was significant different (t = 4.911, 4.679; P < 0.05). The total laser energy of the standard-energy group (47.8 ± 6.0) mJ was higher than the sub-threshold energy group (43.2 ± 5.1) mJ (t = 12.006, 3.233; P < 0.05). However, there was no significant difference in the daily IOP fluctuations, success rate, reduction of medication categories, preoperative and postoperative IOP, and adverse reactions between the two groups. SLT is a safe and effective replacement for medical therapy in primary open-angle glaucoma treatment. SLT could reduce the applications of anti-glaucoma drugs. There was no significant difference between therapeutic effects of which eyes received 360° sub-threshold energy and 270° standard-energy.

Biodegradable 3D-Porous Collagen Matrix (Ologen) Compared with Mitomycin C for Treatment of Primary Open-Angle Glaucoma: Results at 5 Years.

Purpose. To evaluate the effectiveness and safety of the Ologen as an aid for trabeculectomy performed for primary open-angle glaucoma compared with mitomycin C. Methods. In this prospective, randomized, parallel assignment, comparative study, 31 eyes of 21 primary open-angle glaucoma patients were allocated for trabeculectomy with the Ologen implant; another 32 eyes of 23 patients were treated with trabeculectomy augmented with mitomycin C. The patients were followed up for 5 years and evaluated for intraocular pressure, rate of success, status of the bleb, and adverse events. Result. The mean postoperative intraocular pressure was statistically different at 3 m, 6 m, 1 y, 3 y, and 5 y follow-up. The rates of both complete success (P = 0.017) and overall success (P = 0.031) in the Ologen group were significantly higher than those in the mitomycin C group. The difference of the bleb extent and vascularity was statistically significant in both groups. There was no significant difference in postoperative complication. Conclusions. Ologen provides higher rates of surgical success compared with mitomycin C for patients with primary open-angle glaucoma undergoing trabeculectomy. It may be a new, safe, simple, and effective therapeutic approach for treating primary open-angle glaucoma.

PHS51 - Cost-Effectiveness Analysis Of Government Insured Routine Eye Examination: Evidence From Prince Edwards Island, Canada

Primary Open Angle Glaucoma (POAG) is a disease of the optic nerve that is associated with visual field loss and may lead to blindness if uncontrolled1. Blindness caused by POAG is irreversible and since POAG is asymptomatic, many people are unaware they have the disease until late in the disease course2. Late detection increases the risk of blindness. The only treatment for POAG is to lower the intraocular pressure (IOP) to reduce the rate of disease progression. Opportunistic screening for glaucoma may allow for early treatment and reduce the incidence of visual impairment and blindness.

A 4-year retrospective study of add-on therapy to the fixed combination of dorzolamide/timolol for the treatment of POAG.

To evaluate the long-term response to the fixed combination of dorzolamide/timolol in patients with primary open angle glaucoma (POAG) and the addition of other intraocular pressure (IOP) lowering medications such as prostaglandin analogs and brimonidine. A retrospective, non-randomized, and descriptive clinical study was performed with 182 eyes diagnosed with POAG. Patients were divided into three groups: a group with fixed combination of dorzolamide/timolol only, a second group with prostaglandin analogs plus fixed combination of dorzolamide/timolol, and a third group with the addition of brimonidine to the same fixed combination. IOP data were gathered retrospectively and the differences between groups were calculated. IOP was reduced satisfactorily in all three groups; however, a progressive IOP reduction was noted in the group with the fixed combination plus prostaglandin analogs. In this group, a progressive, significant and more homogeneous response of the reduction was noted in comparison with the other groups. IOP reduction was efficacious in all three groups. The addition of prostaglandin analogs showed progressive IOP reduction, progressive response and absence of long-term drift. Brimonidine did not show a significant additive effect.

Фармакоэкономические подходы к оценке лекарственных препаратов для терапии первичной открытоугольной глаукомы

Фармакоэкономические подходы к оценке лекарственных препаратов для терапии первичной открытоугольной глаукомы

Adherence to medical treatment in primary open-angle glaucoma in Egypt

Purpose The aim of the study was to find the state of adherence to medical treatment and the factors affecting it among Egyptian primary open-angle glaucoma patients. Patients and methods A total of 110 adult patients, previously diagnosed with primary open-angle glaucoma, were administered a questionnaire that included most of the potential causes of nonadherence (defined as missing one or more doses of a previously prescribed topical intraocular pressure (IOP)-reducing eye drop during the last 4 weeks) to glaucoma medication reported in the literature (based on age, sex, education level, illness duration, association of other chronic diseases, medication side effects, instillation difficulties, fear of blindness, concept of missing one dose only, hope of prognosis, number of used drugs, and financial cost) during their usual follow-up visit to the outpatient clinic of the Nile Health Insurance Hospital from November 2009 to May 2010. Results Forty-two (38.8%) patients were found to be nonadherent and 68 (61.8%) patients were adherent (no missed doses in the last 4 weeks). Hope of controlling the disease had a statistically significant positive effect on adherence to treatment, whereas the presence of other chronic illnesses had a positive statistically significant effect on nonadherence. The effect of other factors, such as age, sex, education level, illness duration, medication side effects, instillation difficulties, fear of blindness, concept about missing one dose only, number of used drugs, and financial cost, although affecting the adherence level, were statistically insignificant. Conclusion Despite the recent development of drugs with relatively simpler treatments and fewer side effects, nonadherence to topical hypotensive treatment continues to be a considerable obstacle in the treatment of glaucoma patients. The mood of the patient and awareness about his illness are very important factors that determine the adherence level. Fear of blindness and the hope of a good prognosis are powerful motivating factors.

Skin Graft Hypertrichosis Associated With Prostaglandin Analog in the Treatment of Glaucoma

Prostaglandin analogs are commonly used in the treatment of glaucoma. They are a safe and effective treatment associated with few side effects. Common local side effects include conjunctival hyperemia, iris pigmentation, and eyelash hypertrichosis. The authors present a case of a patient using travoprost treatment for primary open-angle glaucoma, who underwent excision of a lower eyelid basal cell carcinoma and reconstruction with an upper eyelid tarsoconjunctival flap and overlying skin graft. The patient developed hypertrichosis of the skin graft attributable to prostaglandin analog use.

Genetics of primary open angle glaucoma

Glaucoma is a neurodegenerative disease and one of the leading causes of irreversible blindness, affecting over 60 million people worldwide. At the present time, glaucoma is clinically defined, but the exact etiology is unknown. Genetic studies are one approach to identify the molecules and pathways involved in disease pathogenesis. Familial aggregation of primary open-angle glaucoma (POAG) has long been recognized, and the analysis of POAG families with a Mendelian inheritance form of this disease has been employed to identify multiple loci linked to them. Some causative genes, such as myocilin, optineurin and WD repeat domain 36, have been identified. However, most cases of POAG are considered to be a prevalent, multifactorial disorder. Several association studies have been conducted for candidate genes, and genome-wide association studies recently identified new susceptibility loci for POAG, namely, S1 RNA binding domain 1 region on chromosome 2p21, the caveolin 1 and caveolin 2 regions on 7q31, transmembrane and coiled-coil domain 1 region on 1q24, cyclin-dependent kinase inhibitor 2B antisense RNA on 9p21, the SIX1 and SIX6 regions on 14q24 and, possibly, the regulatory region of 8q22. Further analysis of clinical manifestations caused by specific genes and functional analysis of these genes will contribute to the development of new strategies for the diagnosis and treatment of POAG.

PSS29 - The Cost-Effectiveness of Bimatoprost 0.03%/Timolol 0.05% Preservative-Free Fixed Combination Compared with Dorzolamide/Timolol Preservative-Free Fixed Combination and 2-Bottle Unfixed Combinations for the Treatment of Primary Open-Angle Glaucoma in the United Kingdom

PSS29 - The Cost-Effectiveness of Bimatoprost 0.03%/Timolol 0.05% Preservative-Free Fixed Combination Compared with Dorzolamide/Timolol Preservative-Free Fixed Combination and 2-Bottle Unfixed Combinations for the Treatment of Primary Open-Angle Glaucoma in the United Kingdom

Adenovirus conducted connective tissue growth factor on extracellular matrix in trabecular meshwork and its role on aqueous humor outflow facility

Deposition of extracellular matrix (ECM) in trabecular meshwork, such as fibronectin, collagen IV, elastin. leads to increased resistance of trabecular meshwork in primary open angle glaucoma (POAG). Connective tissue growth factor (CTGF) is known to regulate the ECM deposits. In this study, we detect the effect of adenovirus conducted CTGF (Adv-CTGF) transfection on either the expression of ECM components or aqueous humor outflow facility. Adv-CTGF was used to transfect rat trabecular meshwork cells in vivo and in vitro. Aqueous humor outflow facility was test by microbeads perfusion. Protein expression of CTGF, fibronectin, and collagen IV was determined using Western blot. In the Adv-CTGF group, the outflow facility displayed a significant decrease from baseline. It appears as though the transfection with Adv-CTGF significantly affects the aqueous humor outflow pattern. A negative correlation between IOP and PEFL indicated that a decrease in the area of bead deposition corresponded to an overall decrease of outflow, leading to an elevated IOP. Adv-CTGF can enhance the expression of CTGF, fibronectin and collagen IV. CTGF is the novel target for treatment of POAG. It is necessary to further study to test inhibition of CTGF expression for treatment of POAG.

Efficacy of Timolol 0.1% Gel and a Prostaglandin Analog in an Unfixed Combination Compared to the Corresponding Fixed Combinations

To investigate the intraocular pressure (IOP) reduction with prostaglandin analogs (PGAs)-timolol fixed combinations versus the unfixed combination of the same PGAs and timolol 0.1% in gel-forming carbomer. Patients with primary open-angle glaucoma (POAG) receiving for at least 4 weeks the fixed combinations of PGA-timolol, administered once a day in the evening (0.005% latanoprost with 0.5% timolol, 0.004% travoprost with 0.5% timolol, 0.03% bimatoprost with 0.5% timolol) were switched to an unfixed combination of the same PGA (once a day in the evening) with timolol 0.1% in gel-forming carbomer (once a day in the morning) for at least 4 weeks. The primary endpoint was to compare efficacy of fixed vs unfixed combinations in lowering IOP. The effects of both regimens on short-term IOP fluctuations were also assessed. A total of 32 patients (64 eyes) fulfilled inclusion criteria: 17 patients received latanoprost-timolol fixed combination, 9 travoprost-timolol fixed combination, 6 bimatoprost-timolol fixed combination. For all considered time periods each unfixed combination induced an IOP reduction significantly higher than the corresponding fixed combination (paired t test: p<0.05 in all measurements). The diurnal IOP reduction was significantly higher during the unfixed combinations (p<0.001). Unfixed combinations significantly decreased IOP diurnal fluctuations and increased the percentage of patients with daily IOP fluctuation ≤2 mm Hg. In this pilot study, PGA and timolol seems to be more effective in POAG treatment when administered as unfixed combinations, reducing both IOP and daily fluctuations. The once a day timolol 0.1% gel-forming carbomer may be a valuable option in PGA-timolol unfixed combination regimen.

Low-dose transscleral diode laser cyclophotocoagulation (TSCPC) as a potential single treatment for primary open-angle glaucoma (POAG) in Malawi?

To investigate if low-dose 810 nm transscleral cyclophotocoagulation (TSCPC) can be used as single treatment in Malawian glaucoma patients. Forty-seven eyes of 28 patients with primary open-angle and pseudoexfoliation glaucoma were treated with TSCPC using 12 spots with 900 mW, 2,000 ms (1.8 J per spot); six spots in the upper half, six in the lower by sparing the 3 and 9 o'clock positions ±20°. Intraocular pressure (IOP) and uncorrected visual acuity (UVA) were measured by an independent examiner preoperatively, on the first postoperative day, after 2 weeks, and after 3 months. Twenty-four (86%) and 18 (64%) of 28 patients (31 of 47 eyes; 66%) completed follow-up at 2 weeks and at 3 months respectively. After a single treatment session, IOP decreased by at least 25 % in 88% (21 of 24) after 2 weeks, and in 50% (nine of 18) of patients after 3 months. Mean IOP was 38.5 mmHg before TSCPC, 23.5 mmHg (p < 0.001) after 1 day, 24.5 mmHg (p < 0.001) after 2 weeks, and 35.6 mmHg (p = 0.37) after 3 months. In three patients, however, IOP increased after 3 months to levels significantly higher than before TSCPC. Low-dose TSCPC caused a significant IOP lowering for up to 2 weeks (15 mmHg less from baseline) in most patients. After 3 months, this effect was stable in 50% of patients; in the other half, IOP nearly returned back to baseline.

Selective Laser Trabeculoplasty for the Management of Open-Angle Glaucoma in St. Lucia

To evaluate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma in an African-derived population in the developing world. Sixty-one subjects from St. Lucia with medically treated primary open-angle glaucoma underwent a 30-day washout, followed by bilateral 360° SLT. Intraocular pressure (IOP) was measured 1 hour; 1 week; and 1, 3, 6, 9, and 12 months after SLT. Mean (SD) IOP with medical therapy was 17.3 (5.0) mm Hg and 17.5 (4.0) mm Hg in the right and left eyes, respectively, and increased to 21.4 (3.6) mm Hg and 21.1 (3.5) mm Hg, respectively, after washout. Both eyes demonstrated a prompt and sustained IOP response to SLT therapy. Intraocular pressure dropped significantly by the first week and remained in the range of 13 to 14 mm Hg without medical therapy through 12 months in patients deemed successful. The mean IOP reductions from baseline ranged from 7.3 to 8.3 mm Hg (34.1%-38.8%) in right eyes and from 7.6 to 8.2 mm Hg (36.0%-38.9%) in left eyes through 12 months. The 12-month Kaplan-Meier survival rate (≥10% IOP reduction from postwashout baseline) was 77.7%, and 93% of successful subjects experienced IOP levels less than with-medication values. Most subjects reported moderate photophobia for 2 to 3 days after SLT; only 1 received anti-inflammatory therapy. Five eyes of 3 subjects had IOP spikes between 5 and 10 mm Hg that resolved without treatment. The magnitude and duration of IOP reduction are clinically relevant in individuals from St. Lucia of African descent. If repeatable, SLT could be a powerful tool for reducing glaucoma-related blindness in this population.

Epidemiological properties of primary open angle glaucoma in Nigeria.

Background. Primary open angle glaucoma (POAG) is progressive chronic optic neuropathy in adults in which intraocular pressure (IOP) and other currently unknown factors contribute to damage. POAG is the second commonest cause of avoidable blindness in Nigeria. Pattern of Presentation. POAG is characterized by late presentation. Absence of pain which is a driving force for seeking medical help, inadequacy of trained eye care personnel, paucity of facilities, misdistribution of resources, lack of awareness, poor education, and poverty may all contribute to this. Medical and surgical treatment options available are challenging and tasking. Screening for Glaucoma. Screening is the presumptive identification of unrecognized disease (POAG) by applying test(s) which can be applied rapidly. Such test(s) should be of high reliability, validity, yield, acceptable, and cost effective. The test should ideally be sensitive, specific, and efficient. It is difficult to select a suitable test that meets these criteria. Intraocular pressure (IOP) appears to be the easiest option. But, high IOP is not diagnostic nor does normal value exclude the disease. Health education is a possible strategy in early case detection and management. Treatment of POAG. Glaucoma treatment can either be medical or surgical (this includes laser). Considering unavailability, potency, cost, and long-term effects of medication, surgery (trabeculectomy) could be a better option. Laser trabeculoplasty is available in a few centers. Viscocanalostomy is not routinely performed. Patient education is vital to success as management is for life. Conclusion. POAG remains a cause of avoidable blindness in Nigeria. There is need for long-term strategy to identify patients early and institute prompt management. Improvement in training of eye care personnel and provision of up to date equipment is essential in achieving this goal.

Laser trabeculoplasty - the first choice surgery for treatment of primary open angle glaucoma

Aim. To analyze the results of laser trabeculoplasty in patients with first and second stage of primary open angle glaucoma with the disease duration over 6 years depending on nature of sclera sinus blockade. Methods. 251 patients aged 38 to 78 years (121 female, 130 males, 285 eyes) with primary open angle glaucoma were observed. The early stage of the disease was observed in 188 eyes, promoted stage of the disease - in 97 eyes. Hypertension, atherosclerosis, diabetes mellitus were among the comorbidities. Visual acuity testing, visual field testing, ocular tonometry and tonography, ophthalmoscopy were performed, sclera sinus blockade features were defined. Laser trabeculoplasty was performed with an argon laser using the universal three mirror lens (600 to 1000 mW, laser beam diameter 50 μm, exposure time 0.1 sec, average number of iterations - 100). Laser linear trabeculoplasty by Wise modified by Mamedov was performed. In case of narrow anterior chamber angle an additional laser gonioplasty by Krasnov and laser peripheral iridotomy were performed prior to trabeculoplasty. Results. In patients with the first stage of the disease in case of a functional blockade the remote hypotensive effect was reached in 81.7% of cases, in case of organic blockade - in 46.7% of cases. In the second stage of an open angle glaucoma decrease in intraocular pressure in functional blockade was reached in 65% of cases, in organic blockade - in 33.3% of cases. Visual acuity decreased in 22.1% of cases. In patients with sclera sinus functional blockade the remote hypotensive effect was twice as better compared to patients with organic blockade. Visual field stabilization in patients with organic blockade was achieved 5.5 times rarely compared to patients with functional blockade. Conclusion. Laser linear trabeculoplasty is still the first choice surgery for primary open angle glaucoma treatment. Defining the nature of sclera sinus blockade allows to predict the laser trabeculoplasty results.

A comparison of the sensitivity of EQ-5D, SF-6D and TTO utility values to changes in vision and perceived visual function in patients with primary open-angle glaucoma

BackgroundEconomic viability of treatments for primary open-angle glaucoma (POAG) should be assessed objectively to prioritise health care interventions. This study aims to identify the methods for eliciting utility values (UVs) most sensitive to differences in visual field and visual functioning in patients with POAG. As a secondary objective, the dimensions of generic health-related and vision-related quality of life most affected by progressive vision loss will be identified.MethodsA total of 132 POAG patients were recruited. Three sets of utility values (EuroQoL EQ-5D, Short Form SF-6D, Time Trade Off) and a measure of perceived visual functioning from the National Eye Institute Visual Function Questionnaire (VFQ-25) were elicited during face-to-face interviews. The sensitivity of UVs to differences in the binocular visual field, visual acuity and visual functioning measures was analysed using non-parametric statistical methods.ResultsMedian utilities were similar across Integrated Visual Field score quartiles for EQ-5D (P = 0.08) whereas SF-6D and Time-Trade-Off UVs significantly decreased (p = 0.01 and p = 0.001, respectively). The VFQ-25 score varied across Integrated Visual Field and binocular visual acuity groups and was associated with all three UVs (P ≤ 0.001); most of its vision-specific sub-scales were associated with the vision markers. The most affected dimension was driving. A relationship with vision markers was found for the physical component of SF-36 and not for any dimension of EQ-5D.ConclusionsThe Time-Trade-Off was more sensitive than EQ-5D and SF-6D to changes in vision and visual functioning associated with glaucoma progression but could not measure quality of life changes in the mildest disease stages.