Comparative study of factors associated with the progression of primary open-angle and angle-closure glaucoma

Lepeshkina

2021

Journal of Glaucoma

To compare the role of spectral-domain optical coherence tomography (SD-OCT) in regard to retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) assessment in the detection of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) progression. Materials and Methods:In the prospective study, 131 subjects with PACG and POAG were examined during 72 months with follow-up visits every 6 months. Visual field (VF) progression was detected using the Guided Progression Analysis (GPA) of the Humphrey visual field analyzer and structural change using SD-OCT while a significant negative trend for the RNFL and GCC was gauged. The diagnostic accuracy of RNFL and GCC thinning in the detection of glaucoma progression was compared between PACG and POAG eyes using the Kaplan-Meier method with the calculation of the logrank test.Results: Progression was detected in 57% of eyes with POAG and 59% of eyes with PACG. The rate of thinning of RNFL (−2.95 ± 1.85 μm/y) and GCC (−3.22 ± 2.96 μm/y) was significantly higher in PACG progression eyes compared with POAG [−1.64 ± 2.00 μm/y (P = 0.018) and −1.74 ± 2.05 μm/y (P = 0.046), respectively]. The progression was associated with initial pattern standard deviation in both glaucoma subtypes, while only in PACG-with long-term intraocular pressure fluctuations (cutoff > 5.2 mm Hg) and lens thickness (cutoff > 4.92 mm), and only in POAG-with initial focal loss volume of GCC (cutoff > 1.5%). In PACG, the rate of the visual function deterioration correlated with GCC thinning rate (r = 0.330, P = 0.027), but not with the RNFL thinning rate (r = −0.010, P = 0.79), while in POAG, it was significant for both RNFL thinning (r = 0.296, P = 0.039) and GCC thinning (r = 0.359, P = 0.011). In PACG patients with progressive GCC thinning, functional progression was detected earlier (log-rank test P ≤ 0.001) than in patients with progressive RNFL thinning (log-rank test P = 0.457), while for POAG, these results were P = 0.012 and ≤ 0.001 for GCC and RNFL thinning, respectively.Conclusions: SD-OCT plays an important role in detecting PACG progression. In contrast to POAG, GCC thinning predicted functional loss better than RNFL thinning in PACG.

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Detection of Primary Angle Closure Glaucoma Progression by Optical Coherence Tomography

Lepeshkina

2021

Journal of Glaucoma

“…Поскольку увеличение ТХф является независимым предиктором развития ПЗУГ и характеризует ее хроническую форму [20], то с помощью ОКТ-визуализации возможно прогнозировать течение ПЗУГ. Согласно нашим исследованиям прогрессирование ПЗУГ ассоциировано именно с увеличением ТХ [40].…”

Section: влияние лекарственных препаратов на толщину хориоидеиunclassified

The Role of Optical Coherence Tomography in the Diagnosis of Angle Closed Diseases of the Anterior Chamber. Part 2: Visualization of the Posterior Segment of the Eye

Шарова

2021

Oftalʹmologiâ

The purpose of this work is to review the literature data on the role of optical coherence tomography in the diagnosis of diseases of the closed angle of the anterior chamber. The analysis of the use of modern technical devices — optical coherence tomography of the posterior segment, models with a frequency-modulated source (Swept Source) is presented. The emergence of new imaging technologies such as SS-OCT contributes to understanding the pathogenesis of primary angle closure diseases in terms of involvement of the choroid in the process. A thicker choroid in the macular area may be an anatomical risk factor for closed angle disease. The expansion of an abnormally thick choroid in combination with the structural features of the anterior segment in eyes with a short axial length, including against the background of psychoemotional stress, can lead to an attack of angle closure. Visualization of the structures of the posterior segment of the eye is an important part of the strategy aimed at solving the problem of identifying risk factors, diagnosing, monitoring and evaluating the effectiveness of treatment of diseases of primary angle closure. Qualitative and quantitative data analysis based on optical coherence tomography significantly increases the diagnostic accuracy, allows to determine its progression and to predict its course. This plays a key role in the choice of treatment tactics for the anterior chamber angle closure. The review considers the effect of local antihypertensive eye drops on the choroid.Conclusion. Optical coherence tomography is a standard in modern diagnostics and evaluation of the effectiveness of treatment of diseases of primary angle closure, allowing a better understanding of the pathogenesis of the disease and its complex nature. Imaging improves the ability to accurately diagnose and choose the right treatment strategy.

The Assessment of Morphological and Functional Changes in the Detection of the Initial Stage of Primary Glaucoma

Lepeshkina²

2021

Oftalʹmologiâ

Purpose — to study morphological and functional changes in the detection of primary glaucoma progression.Patients and methods. 128 patients (128 eyes, among them — 64 eyes with primary open angle glaucoma (POAG) and 64 with primary angle closure glaucoma (PACG)) with the initial MD of –6.0 dB were examined at the Ophthalmology Center of the FMBA of Russia from May 2016 to November 2019. The values of corneal-compensated IOP were also considered: minimal (IOPmin), peak (IOPmax) and its fluctuations (IOPfluct). The progression was measured using standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). During the observation period, each patient received the average of 8.42 ± 2.08 SAP and SD-OCT. Progressive thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated using SD-OCT. If RNFL and/or GCC had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The correlation between the rate of progression detected by SAP (ROP1) using thinning of RNFL (ROP2) and GCC (ROP3) with other clinical parameters was analyzed.Results and discussion. Glaucoma progression was detected in 73 eyes. While the isolated use of SAP did not allow detecting progression, it was possible to detect it in 39 % cases by SD-OCT. The combination of both methods allowed detecting progression in 57 %. In both forms, ROP1 correlated with IOPmin: in PACG r = 0.41, p = 0.023 and in POAG r = 0.43, p = 0.016. In PACG, ROP2 and ROP3 correlated with the foveal choroid thickness: r = 0.46, p = 0.019 and r = 0.47, p = 0.009, respectively. At the same time, ROP3 was associated with peak IOP (r = –0.402, p = 0.025); the correlation of peak IOP with its fluctuations amounted to 0.7 (p < 0.001).Conclusion. SD-OCT is more informative than SAP in determining the progression of the initial primary glaucoma. The combination of these two methods 1.5 times increases the possibility of detecting progression in comparison with the isolated use of SD-OCT. The choroid thickness, associated with the IOP fluctuations, plays an important role in the progression of PACG.