Clinical manifestations of treatment tolerance disorders in patients with primary open-angle glaucoma

<br> Clinical manifestations of treatment tolerance disorders in patients with primary open-angle glaucoma V.E. Korelina¹, Z.M. Nagornova², I.A. Bulakh³, A.V. Kuroyedov^4,5, D.A. Baryshnikova⁶, A.B. Galimova⁷, A.M. Getmanova⁸, V.V. Gorodnichy5, S.A. Zubasheva9, U.R. Karimov¹⁰,&nbsp;S.V. Kosmynina<sup style="font-family: var(--ui-font-family-primary, var(--ui-font-family-helvetica));">11</sup>, E.B. Parova<sup style="font-family: var(--ui-font-family-primary, var(--ui-font-family-helvetica));">4</sup>, A.V. Seleznev<sup style="font-family: var(--ui-font-family-primary, var(--ui-font-family-helvetica));">2</sup>, I.I. Semenova<sup style="font-family: var(--ui-font-family-primary, var(--ui-font-family-helvetica));">12</sup>, T.V. Chernyakova<sup style="font-family: var(--ui-font-family-primary, var(--ui-font-family-helvetica));">4,13</sup>, A.P. Shakhalova<sup style="font-family: var(--ui-font-family-primary, var(--ui-font-family-helvetica));">14</sup> (Scientific Avant-garde Research Group of the Russian Glaucoma Society, 2011–2023©) ¹North West State Medical University named after I.I. Mechnikov, St. Petersburg,&nbsp;&nbsp; Russian Federation ²Ivanovo State Medical University, Ivanovo, Russian Federation ³Ivastramed Medical Center LLC, Ivanovo, Russian Federation ⁴Pirogov Russian National Research Medical University, Moscow, Russian Federation ⁵P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation ⁶Sectoral Clinical Diagnostic Center of the Gazprom PJSC, Moscow, Russian Federation ⁷Bashkir State Medical University, Ufa, Russian Federation ⁸Bryansk Regional Hospital No. 1, Bryansk, Russian Federation ⁹Treatment and Diagnostic Center No. 9, Moscow, Russian Federation ¹⁰Syr Darya Regional Ophthalmic Hospital, Gulistan, Republic of Uzbekistan ¹¹Pavlov-Med LLC, Murmansk, Russian Federation ¹²Mogilev City Hospital of the Emergency Medical Care, Mogilev, Republic of Belarus ¹³52 Advisory and Diagnostic Center of the Ministry of Defense of the Russian Federation,&nbsp;&nbsp; Moscow, Russian Federation ¹⁴Tonus Amaris Medical Clinical Center, Nizhny Novgorod, Russian Federation <b>Aim: </b>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. <b>Patients and Methods: </b>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. <b>Results: </b>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. <b>Conclusion: </b>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. <b>Keywords: </b>glaucoma, intraocular pressure, tolerance, duration of treatment, maximum hypotensive therapy. <b>For citation:</b> 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