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Petja Vassileva, Yordanka Kirilova, Kameliya Naldzhieva; Patients with advanced glaucoma need different treatment approach. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3494. doi: https://doi.org/.
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To discuss the main factors for different treatment approach in patients with advanced glaucoma.
23 patients (45-82 years old) referred and diagnosed with advanced glaucoma for a period of 2 months were analyzed. All patients underwent full eye exam and specialized diagnostic procedures (SAP and Stratuss OCT analysis of optic disc and RNFL, including imaging of lamina cribrosa stability and deformation). Structure- function correspondence was evaluated. Diagnostic criteria for advanced disease included decreased visual acuity, visual field changes (-10/-20dB), large cupping and glaucoma progression during a follow- up of 6 months.
23 patients of 87 patients referred to our clinic with glaucoma were diagnosed with advanced stage of the disease. The majority of patients (65%) were diagnosed with XFG, 22% - PACG, 9% - SG and 4% PAOG. The most important risk factors for glaucoma progression were as follows: the clinical form of glaucoma, early onset and longer duration of the disease, fluctuation of eye pressure, age of the patients. Additional risk factors were exfoliation syndrome, arterial hypotony and systemic cardiovascular problems. Most rapid progression was diagnosed in patients with low tension glaucoma and in chronic angle closure glaucoma. In these patients we have offered more aggressive intraocular pressure lowering treatment and considered earlier surgical intervention. Main criteria for the different treatment approach: young age, advanced glaucomatous changes at presentation, insufficient glaucoma control with multiple medications. The glaucoma stage of the other eye was important factor for the therapeutic decision, especially in unilateral glaucoma blindness. The majority of patients (87%) underwent surgical treatment: immediate surgery on 4 pts (17%) and consecutive surgery on 10 pts (44%). The rest of the patients were prescribed antiglaucomatous medications because of serious operative risk from systemic disease.
Our clinical observations of patients with advanced glaucoma demonstrated more rapid progression. Multiple measurements and at multiple times were necessary as IOP is a “moving target”. We must learn to identify those patients and they should be offered different, more aggressive personalized glaucoma therapy in order to prevent severe visual loss.
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