Clinical manifestations of treatment tolerance disorders in patients with primary open-angle glaucoma
Authors:   North West State Medical University named after I.I. Mechnikov, St. Petersburg, Russian Federation, Korelina V.E. , Nagornova Z.M. ,   Ivanovo State Medical University, Ivanovo, Russian Federation, Bulakh I.A. ,   Ivastramed Medical Center LLC, Ivanovo, Russian Federation, Baryshnikova D.A. ,   Sectoral Clinical Diagnostic Center of the Gazprom PJSC, Moscow, Russian Federation, Kuroyedov A.V. ,   Pirogov Russian National Research Medical University, Moscow, Russian Federation,   P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation, Galimova A.B. ,   Bashkir State Medical University, Ufa, Russian Federation, Getmanova A.M. ,   Bryansk Regional Hospital No. 1, Bryansk, Russian Federation, Gorodnichy V.V. ,   P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation, Zubasheva S.A. ,   Treatment and Diagnostic Center No. 9, Moscow, Russian Federation, Karimov U.R. ,   Syr Darya Regional Ophthalmic Hospital, Gulistan, Republic of Uzbekistan, Kosmynina S.V. ,   Pavlov-Med LLC, Murmansk, Russian Federation, Parova E.B. ,   Pirogov Russian National Research Medical University, Moscow, Russian Federation, Seleznev A.V. ,   Ivanovo State Medical University, Ivanovo, Russian Federation, Semenova I.I. ,   Mogilev City Hospital of the Emergency Medical Care, Mogilev, Republic of Belarus, Chernyakova T.V. ,   Pirogov Russian National Research Medical University, Moscow, Russian Federation,   52 Advisory and Diagnostic Center of the Ministry of Defense of the Russian Federation, Moscow, Russian Federation, Shakhalova A.P. ,   Tonus Amaris Medical Clinical Center, Nizhny Novgorod, Russian Federation
Published: December 2024

Aim: to determine the clinical manifestations of treatment tolerance disorders in patients with primary open-angle glaucoma (POAG) with
different duration of the disease, timing and treatment regimens.
Patients and Methods: the final protocol of the cohort scientific clinical combined multicenter study included the case monitoring results in
115 patients (115 eyes) with advanced and severe stages of POAG; according to duration of the verified medical history, they were divided into
two groups: 0.72 [0.32; 0.92] and 2.7 [1.9; 3.8] years. The indicators and characteristics (age, the disease stage, medical history, intraocular
pressure level, hypotensive regimen and treatment satisfaction according to the Treatment Satisfaction Survey for Intraocular Pressure/TSS-
IOP questionnaire) that may represent POAG treatment efficacy and tolerability criteria were studied.
Results: age, intraocular pressure (IOP) level at the diagnosis verification timepoint and final examination in POAG patients were comparable
in both groups. In spite of a significant decrease in IOP level due to local hypotensive therapy, morphometric parameters decreased. Patients
experienced from one to five changes of treatment regimens. This was associated with both the IOP level and morphometric changes. The
maximum hypotensive therapy was the most efficient and longest one, while monotherapy with beta-blockers showed the worst efficiency. TSS-
IOP data analysis showed that, despite local adverse effects of antiglaucoma therapy, visual functions is a priority for the majority of patients.
Conclusion: the study showed that tolerance to POAG treatment develops in a large number of patients at a fairly early stage. Initial
monotherapy becomes ineffective in 79.6% of patients during the first six months of the treatment. A stepwise (conventional) approach to
hypotensive glaucoma therapy is ineffective in patients with advanced and severe stages of POAG. The longer antihypertensive treatment
duration, the more changes in local hypotensive therapy regimens were performed.
KEYWORDS: glaucoma, intraocular pressure, tolerance, duration of treatment, maximum hypotensive therapy.
FOR CITATION: Korelina V.E., Nagornova Z.M., Bulakh I.A., Kuroyedov A.V., Baryshnikova D.A., Galimova A.B., Getmanova A.M., Gorodnichy
V.V., Zubasheva S.A., Karimov U.R., Kosmynina S.V., Parova E.B., Seleznev A.V., Semenova I.I., Chernyakova T.V., Shakhalova A.P. (Scientific
Avantgarde Research Group of the Russian Glaucoma Society, 2011–2023©). Clinical manifestations of treatment tolerance disorders in
patients with primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2024;24(4):159–169 (in Russ.). DOI: 10.32364/2311-
7729-2024-24-4-1