Treatment of patients with the initial stage of primary open-angle glaucoma. Difficulties of choice

Purpose. The purpose of this study is to evaluate the effectiveness of various treatment methods for early stage POAG. Material and methods. The study included 298 patients (298 eyes) with the initial stage of POAG, who were treated in the glaucoma department at the Federal State Institution National Medical Research Center MNTK Eye Microsurgery named after. acad. S.N. Fedorov of the Russian Ministry of Health from 2020 to 2022. The patients were divided into 3 groups. Patients of group 1 (101 patients – 101 eyes) were administered local antihypertensive therapy with prostaglandin analogues, patients of group 2 (99 patients – 99 eyes) underwent selective laser trabeculoplasty (SLT), patients of group 3 (98 patients – 98 eyes) – non-penetrating deep sclerectomy (NPDS). The follow-up period was 3 years. Results. The effectiveness of prostaglandin monotherapy was 66.3%, while by 3 years of follow-up, SLT was performed in 22 cases (21.8%), and NPDS was required in 12 cases (11.9%). The effectiveness of SLT in the second group was 73.7%, in 34 cases (34.3%) SLT had to be repeated and in 15 cases (15.2%) of them a subsequent NPDS was performed, 11 cases (11.1%) required intensification of antihypertensive regimens. The efficacy of two-stage treatment in group 3 (NPDS + descemetogoniopuncture (DGP)) was 85.7%, with DGP performed in 42 cases (42.8%), antihypertensive regimens intensified in 14 cases (14.3%). Conclusion. The effectiveness of prostaglandins was 66.3% at baseline, SLT – 73.7%, NPDS – 85.7% Key words: primary open-angle glaucoma, treatment at the initial stage, antihypertensive therapy, selective laser trabeculoplasty, non-penetrating deep sclerectomy