Target intraocular pressure level in patients with different stages of low tension glaucoma; [Показатели «целевого» уровня внутриглазного давления у пациентов с разными стадиями глаукомы низкого давления]

Abstract

Aim: to determine a level of "target" intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG), depending on the disease stage. Patients and Methods: a final protocol of a multicenter scientific analytical selective combined study conducted in 6 countries (Russia, China, Belarus, Serbia, Slovakia and Uzbekistan) at 25 clinical centers included data from 269 patients. The stage of glaucoma was confirmed by ophthalmoscopy and/or fundus photography and/or optical coherence tomography and/or Heidelberg tomography, and standard automatic perimetry (SAP). Visual acuity was examined, clinical refraction was determined, a tonometric level of IOP was measured (Maklakov tonometry with a 10 g load, Caucasian population), and Goldman tonometry results (Asian population) were evaluated. Results: at diagnosis, patients with NTG were several years younger than those with primary open-angle glaucoma (POAG). The greatest increase in glaucoma progression was reported in patients with the advanced disease (+91.4%), while a number of patients with stages I and II decreased by 5.5% and 23.4%, respectively. In patients with mild NTG (stage I), IOP level reduced by 19.9% and 16.6% from the initial values when measured by Maklakov and by Goldman methods, respectively. In patients with stages II и III, the parameter values decreased by 17.1% and 9.4% (on average, by 14.1%), as well as by 21.9% and 9.3% (on average, by 15.3%), respectively. Only among patients with advanced NTG, the progression rate was approximately 7 times higher in individuals with the appropriate family history (p=0,016; U=2,416). Conclusion: regardless of the disease stage, the lower an initial IOP level, the less it can be reduced towards the final examination. During the entire follow-up period, an average decrease in the IOP level was 16.5% regardless of the NTG stage. Due to the treatment provided, IOP in NTG patients was on average 2-4 mm Hg lower than that in individuals with POAG. Thus, current guidelines to determine "target" values of the parameter in this group of patients should be amended. © 2025 Medicine-Inform LLC. All rights reserved.