Comparative analysis of the course of primary open-angle glaucoma based on the results of clinical observation of patients in a polyclinic

Purpose. To conduct a comparative assessment of the course of primary open-angle glaucoma (POAG) under dynamic observation in a polyclinic. Material and methods. In our series of 334 cases of glaucoma, 277 were males and 57 were females. The age of the patients was 75.5 ± 8.3 years for males and 75.6 ± 7.5 years for females. Time since diagnosis was 8.6 ± 7.4 years for males and 8.1 ± 6.8 years for females. Glaucoma was newly diagnosed in males at the age of 66.9+9.7 years, in females – 67.5 ± 9.1 years (p > 0.05). The distribution of POAG by stage was as follows: suspected glaucoma – 5%; POAG I st. – 64.5%, POAG II st. – 11.8%, POAG III st. – 13.4%, POAG IV st. 5.3%. The following factors were taken in consideration: stage of glaucoma, time under observation, best corrected visual acuity, IOP, topical therapy, surgery procedures. The study results were compared with data collected in 2020–2021. Results. A significant increase was found in the proportion of patients with suspected glaucoma (from 2.4% to 5.0%) and POAG I st. (from 46% to 64.5%) (p < 0.001), when compared to data collected in 2020–2021. Topical antihypertensive therapy was required for 98% of glaucoma patients: 35.1% of patients received mono-therapy and 62.6% of patients multitherapy. There was a significant increase in the proportion of CAIs (carbonic anhydrase inhibitors) by 15.9% (p < 0.01) and a decrease in the proportion of beta-blockers (BB) by 18.7% (p < 0.001). There was a significant increase in the proportion of combinations of PG (prostaglandins and their analogues) + CAIs by 12.1% (p < 0.001) and a decrease in the proportion of combinations of CAIs + BB and PG + BB by 12.9% (p < 0.001). A comparative analysis showed an increase of 8.3% in cases of achieving the target IOP (from 76.6% to 84.9%). Statistically significant direct correlations were found between the duration of glaucoma and the number of drops instilled (R = 0.15; p < 0.05), as well as between the stage of glaucoma and the number of drops instilled (R = 0.28; p < 0.05). Surgical treatment of glaucoma was performed in 14.1% of cases. (in 2020–2021 – 12.6%), there was a significant increase in the proportion of operated patients with glaucoma, depending on the stage of the disease: POAG I st. – 4.5%; POAG II st. – 12.8%; POAG III st. – 44.3%; POAG IV st. – 57.0%. Despite the surgical treatment, additional local drug therapy for glaucoma was required in 88.6%, including monotherapy in 21.6%, combined therapy in 67%. Conclusion. A comparative assessment of the clinical parameters of glaucoma patients showed a significant increase in the proportion of patients with the initial stage of glaucoma, a change in the structure of local drug therapy – an increase in the proportion of IR and a decrease in the proportion of BB both with monotherapy and with combined treatment, as well as an increase of 8.3% in cases of achieving the target pressure. Keywords: primary open-angle glaucoma; drug treatment; eye drops; comparative assessment