ДИНАМИКА ИЗМЕНЕНИЙ НА ГЛАЗНОМ ДНЕ БОЛЬНЫХ НОРМОТЕНЗИВНОЙ ГЛАУКОМОЙ ПОД ВЛИЯНИЕМ МЕСТНОЙ ГИПОТЕНЗИВНОЙ ТЕРАПИИ

Abstract

Introduction. Glaucoma with normal and low intraocular pressure (IOP) continues to be a topic of lively debate among clinicians. IOP, remaining within the average statistical norms but exceeding the patient's tolerable values, can cause irreversible atrophic changes in the optic nerve head. Objective. To identify and analyze the nature and degree of reversibility of optic nerve head changes in patients with normotensive glaucoma under the influence of local hypotensive and systemic stimulating and neuroprotective therapy.

 Materials and Methods. This study analyzes clinical observations of 28 eyes of 14 patients with primary open-angle glaucoma with low initial IOP. All patients underwent visometry with optimal spectacle correction, biomicroscopy, ophthalmotonometry with a Maklakov tonometer and an electronic pneumotonometer, ophthalmoscopy, and fundus photography with a Carl Zeiss fundus camera. The vertical cup diameter and the cup-to-optic disc diameter ratio were determined. The thickness of the neurosensory retinal layer was determined using optical coherence tomography on a Heidelberg Engineering device (Germany). Tolerance intraocular pressure was determined using the perimetric version of A.M. Vodovozov's test.

Results. The vertical diameter of the cup was, on average, 1.2±0.2 mm at the beginning of the observation. The ratio of the cup and disc diameters was, on average, 0.4±0.1. During timolol instillations, tolerable pressure was achieved in 15 out of 18 eyes (83%); it was, on average, 15.8±0.4 mmHg. With multiple repeated measurements of the vertical diameter of the cup, it was, on average, equal to 1.1±0.4 mm. The reliability between the state at the beginning of the observation and after 8 months was p≤0.05. The "cup-disc" index at the late stages of observation was 0.3±0.1, p≤0.05. The obtained data allow us to state the stabilization of the optic nerve head as the ophthalmotonus decreases. However, the significance of differences between the initial observation period and later follow-up is relatively low, indicating the irreversible nature of these changes.

Conclusion. Local hypotensive therapy combined with general nutritional and neuroprotective therapy allowed for stabilization of the process in a significant proportion (83%) of patients. Stabilization was achieved in almost all eyes, where IOP was reduced to a tolerable level and maintained there throughout the entire observation period.