ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2019-1S-96-101ophthalmology-906Research ArticleКЛИНИЧЕСКИЕ И ЭКСПЕРИМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL & EXPERIMENTAL RESEARCHПрогрессирование глаукомной оптиконейропатии: результаты многолетнего наблюденияGlaucoma Optic Neuropathy Progression: the Results of Long-Term Follow-UpКурышеваН. И.KuryshevaN. I.

доктор медицинских наук, профессор, заведующая консультативно-диагностическим отделомул. Гамалеи, 15, Москва, 123098, Российская Федерация

MD., Professor, Head of the Consultative-Diagnostic Department of Ophthalmology CenterGamalei str., 15, Moscow, 123098, Russia

e-natalia@list.ruТрубилинВ. Н.TrubilinV. N.

доктор медицинских наук, профессор, заведующий кафедрой офтальмологииВолоколамское ш., 91, Москва, 125371, Российская Федерация

МD, рrofessor, head of the ophthalmology departmentVolokolamskoye highway, 91, Moscow, 125371, Russia

ШаталоваЕ. О.ShatalovaE. O.

врач-офтальмологул. Набережная, 10а, Орехово-Зуево, Московская область, 142611, Российская Федерация

оphthalmologistNaberezhnaja str., 10A, Orechovo-Zuevo, Moscow region, 142611, Russia

ЛепешкинаЛ. В.LepeshkinaL. V.

врач-офтальмологул. Гамалеи, 15, Москва, 123098, Российская Федерация

оphthalmologistGamalei str.,15, Moscow, 123098, Russia

Консультативно-диагностическое отделение Центра офтальмологии Федерального медико-биологического агентства РоссииРоссияThe Ophthalmological Center of the Federal Medical and Biological Agency of Russian FederationRussian FederationАкадемия постдипломного образования ФГБУ ФНКЦ ФМБА РоссииРоссияAcademy of postgraduate education under FSBU FSCC of FMBA of RussiaRussian Federation«Клиники доктора Шаталова»Россия«Clinics of doctor Shatalov»Russian Federation201922042019161S96101Copyright © Курышева Н.И., Трубилин В.Н., Шаталова Е.О., Лепешкина Л.В., 20192019Курышева Н.И., Трубилин В.Н., Шаталова Е.О., Лепешкина Л.В.Kurysheva N.I., Trubilin V.N., Shatalova E.O., Lepeshkina L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/906

Цель работы: исследовать среднюю скорость и факторы риска прогрессирования глаукомной оптиконейропатии (ГОН) при длительном наблюдении. Пациенты и методы. Первично было отобрано 750 человек, наблюдавшихся в течение 10 лет, у которых рассчитывали среднюю скорость прогрессирования ГОН. В соответствии с принятыми в рамках данного исследования критериями включения/исключения из этих больных была сформирована группа ретроспективного анализа, в которую вошли 128 пациентов. Результаты. В ходе исследования выявлены факторы риска прогрессирования ГОН: исходное роговично-компенсированное ВГД (ВГДрк) > 23,6 мм рт. ст. (AUC 0,7) и ВГДрк через 5 лет > 19,8 мм рт. ст. (AUC 0,83), возраст > 69,5 года (AUC 0,6), корнеальный гистерезис < 9,9 мм рт. ст. (AUC 0,6) и СНВС < 92 мкм (AUC 0,6). В зоне риска оказались также пациенты с псевдоэксфолиативным синдромом и больные, принимающие системные блокаторы кальциевых каналов (p = 0,01). У пациентов с артериальной гипертензией ГОН прогрессировала реже (р = 0,015), как и у больных, получавших аналоги простагландинов (риск снижен в 5 раз, p = 0,04) и фиксированные комбинации (риск снижен в 2 раза, p = 0,018). ВГДрк выше 17,6 мм рт. ст. в отдаленном периоде является наиболее выраженным фактором риска прогрессирования ГОН. Было определено, что средняя скорость прогрессирования наблюдаемых за 10 лет больных глаукомой составила 0,6 дБ/год для ROP1, 0,62 ± 1,09 мкм/год для ROP2 и 0,95 ± 3,28 мкм/год для ROP3. В группе с прогрессированием ГОН снижение светочувствительности на 1 дБ/год приводило к уменьшению параметра RNFL на 3,9 мкм/год. Применение аналогов простагландинов и фиксированных комбинаций снижает риск прогрессирования заболевания.

Purpose: to investigate the average speed and risk factors for the glaucomatous optic neuropathy (GON) progression during longterm observation. Patients and methods. The 10-year data of 750 patients were analyzed. The average GON progression rate was calculated on the basis of perimetry and optical coherent tomography data. Further, according to inclusion and exclusion criteria 128 patients were included into the group of retrospective analysis. Resultes. The following risk factors were established: initial cornealcompensated IOP (IOPcc) > 23.6 mm Hg (AUC 0.7), IOPcc after 5 years > 19.8 mm Hg (AUC 0.83), age > 69.5 years (AUC 0.6), corneal hysteresis < 9.9 mm Hg (AUC 0.6) and retinal nerve fiber layer < 92 μm (AUC 0.6). Patients with pseudoexfoliation syndrome, and patients taking systemic calcium channel blockers (p = 0.01) also had the higher risk of GON progression. Its rate was lower in patients with arterial hypertension (p = 0.015), and in patients who received prostaglandin analogues (risk was 5 times reduced, p = 0.04) and fixed combinations (risk was 2 times reduced, p = 0.018). IOPcc of higher than 17.6 mm Hg in the long-term period is the most pronounced risk factor for the progression of GON. It was determined that the average ROP of glaucoma progression among the patients was 0.6 dB/year for ROP1, 0.62 ± 1.09 μm/year for ROP2 and 0.95 ± 3.28 μm/year for ROP3, also each 1 dB/year decrease in photosensitivity (in group with glaucoma progression) was associated with further loss of RNFL (3.9 µm/year). Conclusion. The use of prostaglandin analogues and fixed combinations reduces this risk.

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Ophthalmology. 2007;114(12):2221–2226. DOI: 10.1016/j.ophtha.2007.03.047Muskens R.P., De Voogd S, Wolfs R.C., et al. Systemic antihypertensive medication and incident open-angle glaucoma. Ophthalmology. 2007;114(12):2221–2226. DOI: 10.1016/j.ophtha.2007.03.047Wei Zheng, Thaddeus P. Dryja. Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma. Ophthalmology 2018. DOI: 10.1016/j.ophtha.2018.01.007Wei Zheng, Thaddeus P. Dryja. Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma. Ophthalmology 2018. DOI: 10.1016/j.ophtha.2018.01.007Wei Zheng, Thaddeus P. Dryja. Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma. Ophthalmology 2018. DOI: 10.1016/j.ophtha.2018.01.007Wei Zheng, Thaddeus P. Dryja. Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma. Ophthalmology 2018. DOI: 10.1016/j.ophtha.2018.01.007

The authors declare that there are no conflicts of interest present.