National Journal glaucoma最新文献

{"title":"Technical difficulties of adequate assessment of intraocular pressure in a patient with glaucoma in the long term after corneal refractive surgery (clinical case)","authors":"N. A. Kuleshova, O. V. Kolenko, E. L. Sorokin","doi":"10.53432/2078-4104-2023-22-1-76-84","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-76-84","url":null,"abstract":"PURPOSE. To demonstrate a clinical case involving difficulties in adequate assessment of intraocular pressure (IOP) in a patient with glaucoma in the long term after LASIK.METHODS. The study describes the case of patient M. of 58 years old with complaints about decreased distance vision in the right eye during the last year. In 2004 the patient underwent LASIK for moderate myopia. In 2018, asymmetry in the parameters of optic nerve head (size of the optic cup to the optic disc ratio (C/D ratio) was revealed: in the right eye — up to 0.7, narrowing of the visual field from nasal to fixation point; in the left eye — 0.5, visual fields without abnormalities. The IOP measured using the Maklakov method in both eyes corresponded to the average statistical norm — 22 mm Hg. The following diagnosis was established: IIA primary open-angle glaucoma in the right eye, IA primary open-angle glaucoma in the left eye. One-time instillations of latanoprost 0.005% eye drops solution was indicated for both eyes. In subsequent years the IOP was 18–20 mm Hg. After 4 years, the IOP according to the Maklakov method: OD — 18 mm Hg; OS — 21 mm Hg (on the hypotensive regimen — instillations of latanoprost 0.005% eye drops solution). In the right eye: C/D ratio 0.85–0.9 with absolute scotoma in the Bjerrum area 5–15° from fixation; in the left eye: C/D ratio 0.9 with neuro retinal rim loss from below, with absolute scotoma in the blind spot area. The stages of primary open-angle glaucoma were ascertained: IIIA in the right eye, IIA in the left eye.RESULTS. Selective laser trabeculoplasty was performed. Brimonidine 0.1% solution was added due to the lack of complete stabilization of the IOP level on a single instillation of latanoprost 0.005%, after that IOP decreased to 19 mm Hg in both eyes.CONCLUSION. It is necessary to carefully assess the condition of the structures of the optic nerve head in patients after LASIK, regardless of the statistically normal IOP values.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"9 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131957482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern possibilities of laser surgery in the treatment of primary open-angle pigmentary glaucoma","authors":"V. P. Fokin, S. V. Balalin, A. Sarkisyan, A. S. Balalin","doi":"10.53432/2078-4104-2023-22-1-67-75","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-67-75","url":null,"abstract":"PURPOSE. To analyze the effectiveness of the complex method of pigmentary glaucoma laser surgery: YAG-laser iridectomy and multistep selective laser trabeculoplasty (SLT).METHODS. We examined 18 patients (36 eyes) between 13 and 54 years old with primary open-angle pigmentary glaucoma: initial stage was detected in 13 patients (26 eyes), moderate stage — in 4 patients (8 eyes), advanced stage — in 1 patient (2 eyes). Laser iridectomy was performed as the first stage after individual IOP level was reached by drug therapy. SLT was performed 4 weeks later and was repeated around the trabecula every 4–6 months if exogenous pigmentation exceeded grade II. The observation period lasted 4 to 15 years.RESULTS. The glaucoma process was stabilized successfully in all cases. True IOP decreased by 6.6±0.3 mm Hg (-30%, p<0.05), Becker’s coefficient — by 121±4.3 (-60%, p<0.001), the number of drug instillations — by 1.32±0.06 (-70%, p<0.001). The following indicators increased: mean total retinal photosensitivity — by 381±4.3 dB (15%, p<0.001), mean threshold of retinal photosensitivity — by 2.6±0.1 dB (10%, p<0.001), ease of intraocular liquid outflow — by 0.08±0.013 (72%, p<0.001). Hypotensive drug therapy was canceled in 15 cases (41.7%).CONCLUSION. Laser surgery of pigmentary glaucoma consisting of YAG-laser iridectomy combined with multistep SLT is an effective and safe method. It can be performed if the elevated IOP is normalized to the individual norm by drug therapy.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124205154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical and topographical characteristics of the eye in the early stages of primary angle closure disease","authors":"N. Kurysheva, G. Sharova","doi":"10.53432/2078-4104-2023-22-1-42-53","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-42-53","url":null,"abstract":"PURPOSE. To determine the anatomical and topographic features of the anterior and posterior segments of the eye in primary angle closure (PAC) and compare them with those in the primary angle closure suspects (PACs) and in controls.METHODS. This prospective study included 120 patients aged 41 to 80 years (60 eyes — PAC, 30 — PACs, 30 eyes — without ophthalmic pathology). The studied parameters included spherical equivalent (SE), intraocular pressure (IOP), choroidal thickness in the fovea (CTf), axial length (AL), anterior chamber depth (ACD), lens volume (LV), iris curvature and its thickness, anterior chamber angle profile: AOD500, AOD750, TISA500, TISA750.RESULTS. The PAC eyes differed from the control eyes by increased SE, LV, IOP, iris curvature, CTf, reduced ACD, AL, and the anterior chamber profile (AOD500, AOD750, TISA500, TISA750) in vertical sectors (p<0.01). Iris thickness was comparable between the groups.The PAC eyes differed from the PACs by increased SE, LV, IOP, reduced ACD, AL, AOD500 in the superior sector, and the profile of the anterior chamber angle in the inferior sector (p<0.01). Iris thickness, its curvature, as well as the profile of the anterior chamber in the upper sector and CTf were comparable.Threshold values that distinguish the PAC eyes and the PACs were determined: LV — 0.656 mm, AOD500 — 0.131 mm, TISA500 — 0.051 mm2, TISA750 — 0.093 mm2 in the lower sector and IOP 21 mm Hg. In the multifactor model adjusted for age, gender and AL, a negative correlation of iris thickness with CTf was established both in the PAC eyes and the PACs (all p<0.01), but not in the controls (all p>0.01). CONCLUSION. Parameters of the PAC eyes and the PACs significantly differ from the norm. LV and the anterior chamber profile in the inferior sector are the most informative for differentiating the PAC eyes from the PACs. Negative correlation between the iris and the choroidal thickness suggests that the choroid plays a role in the pathogenesis of primary angle closure disease.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133810838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capabilities of the portable perimeter in the examination of visual field of bedridden patients (preliminary results)","authors":"V. Erichev, Y. V. Levitsky, L. Grigoryan, A. Ermolaev","doi":"10.53432/2078-4104-2023-22-1-35-40","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-35-40","url":null,"abstract":"PURPOSE. To study the capabilities of perimetry in patients who are physically unable to take and maintain the correct position at the stationary perimeter during the time required for examination.METHODS. The study examined 40 eyes (34 patients) with stage II–III glaucoma using the portable perimeter (PP) with patients in the sitting and lying positions. Screening perimetry with Humphrey Visual Field (HFA-II) performed in patients in the sitting position was used as control. In all cases, perimeter strategy of 30-2 was used involving presentation of 76 light stimuli in the zone of 30° from the gaze fixation point. To be able to compare the results obtained on HFA-II in the sitting position and on PP in the lying position, the results obtained with the help of PP in the sitting position were used as the \"gateway group\" (logical link).RESULTS. Comparison of the results obtained using the above-mentioned approaches revealed good visual comparability of perimeter maps with small individual deviations that require more detailed analysis on more clinical data using statistical and mathematical methods, which is a subject of further research. In that case, it will be necessary to take into account the presence of an orthostatic factor affecting intraocular blood flow at different positions of the patient.CONCLUSION. Portable perimetry is an effective method for examining the visual field of low-mobility and bedridden patients who are physically unable to undergo a perimetry examination on stationary devices.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121126685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glaucoma in pregnant women: features of treatment","authors":"T. Y. Matnenko, A. V. Yurlagina, O. I. Lebedev","doi":"10.53432/2078-4104-2023-22-1-103-114","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-103-114","url":null,"abstract":"This review provides information on the features, incidence, pathogenetic mechanism, possibilities of conservative, laser and surgical treatment of glaucoma in pregnant women. The purpose of this literature review is to study the features of managing patients with glaucoma during pregnancy. Glaucoma is a large group of eye diseases characterized by a gradual development of visual impairments and atrophy of the optic nerve. The pathology is most common among the population over 40 years old, but due to the advancement of reproductive technologies, the availability of diagnostic methods, as well as high clinical awareness, the frequency of ophthalmologists managing glaucoma in pregnant women increases. Elevated intraocular pressure in pregnant women is becoming more common and, therefore, is an urgent problem. There is a trend towards an increase in the number of pregnant women who experienced elevated intraocular pressure for the first time. Previously identified pathology in childhood or secondary glaucoma due to previous ophthalmic diseases or severe somatic pathology is a special category of patients. Such patients are encountered regularly and require close supervision by both an ophthalmologist and a gynecologist. The evidence base for antiglaucoma drugs is small; there are clinical experiments on animals, which results do not always carry over to humans, and retrospective studies. The doctor's arsenal presently includes a number of drugs that have possible side effects for the fetus, as well as laser and surgical treatment. There is no standard treatment, so each case should be considered individually with an understanding of the physiology, mechanism of action of the drugs and their possible effects. Therefore, glaucoma during pregnancy and lactation is a serious medical problem, and its solution depends on interdisciplinary medical approach.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130872390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern-electroretinogram in the differential diagnosis of ocular hypertension and primary open-angle glaucoma","authors":"E. Tur, T. Y. Kozhevnikova","doi":"10.53432/2078-4104-2023-22-1-25-34","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-25-34","url":null,"abstract":"PURPOSE. To evaluate the clinical utility of pattern electroretinography (PERG) in the differential diagnosis of ocular hypertension and newly diagnosed primary open-angle glaucoma (POAG) of the initial stage.METHODS. This prospective non-randomized cohort study included patients over the age of 35 years with newly diagnosed ocular hypertension and initial stage POAG in at least one eye. All patients underwent a standard ophthalmological examination, as well as a complex of additional methods used to diagnose POAG: pachymetry, examination of the biomechanical properties of the cornea (Ocular Response Analyzer, Reichert), standard automated perimetry (SAP) (Octopus 900, Haag-Streit Diagnostics), optical coherence tomography (OCT) of the optic nerve head (ONH) and macular area (OCT Triton Plus 3000, Topcon) and PERG (Diopsys Nova, Diopsys, Inc.). Data from both eyes of all included patients were analyzed (12 eyes in the ocular hypertension group and 26 eyes in the POAG group). Statistics was calculated using the StatPlus:mac Software package (StatPlus Inc., Taiwan).RESULTS. During this study we recorded statistically significant differences in steady-state PERG parameters according to the PERG-24 protocol (magnitude, magnitude D — taking into account the magnitude and variability of the response phase throughout the test — and their reverse ratio, determined at pattern contrasts of 100% and 85%) between the groups of patients with newly diagnosed ocular hypertension and newly diagnosed initial stage POAG with a comparable level of intraocular pressure, corneal thickness, biomechanical properties and comparable perimetric indices, as well as the average thickness of the retinal nerve fiber layer and the ganglion cell complex according to OCT data. At the same time, all PERG parameters in the ocular hypertension group were within the normal range, while individual PERG parameters in the POAG group had deviations from the normal.CONCLUSION. Steady-state PERG may be an additional objective method for early detection of disorders in the functioning of retinal ganglion cells (RGCs), which allows differential diagnosis of ocular hypertension without damage of RGCs and initial stage POAG. In addition, dynamic examination with steady-state PERG of individuals with ocular hypertension may allow early detection of the onset of retinal ganglion cells death, i.e. the development of POAG, than with SAP and OCT.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132432879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On adequate zones of true intraocular pressure in healthy and glaucoma eyes","authors":"O. Svetlova, I. Koshits, R. M. Pankratov, O. V. Makarovskaya, M. Zaseeva","doi":"10.53432/2078-4104-2023-22-1-3-23","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-3-23","url":null,"abstract":"PURPOSE. The study was conducted to reveal using the Ocular Response Analyzer (ORA) the possible ranges of mean values of the “rigidity” and “fluctuation” criteria for fibrous membrane of healthy and glaucoma eyes with consideration of the age periods according to the classification by WHO, and to identify adequate true intraocular pressure (IOP) zones corresponding to these ranges.METHODS. The study consisted of a theoretical analysis of clinical measurements of rigidity and fluctuation of the fibrous membrane, the current level of true IOP and the individual level of IOP calculated in youth using ORA by the method of dynamic diagnosis of Koshitsa-Svetlova, and involved in total 674 healthy and 518 glaucoma eyes from individuals aged 18 to 90 years, who were distributed by age periods according to WHO.RESULTS. A \"step pattern\" of the distribution of Average values of rigidity and fluctuation in healthy and glaucoma eyes were distributed in a “step pattern”, which made it possible to rank the IOP zones adequately to these steps, taking into account the age periods according to WHO. The following adequate ranges of IOP levels for healthy and glaucoma eyes were identified: low IOP zone (up to 13 mm Hg); medium IOP zone (14–20 mm Hg); elevated IOP zone (21–26 mm Hg); high IOP zone (27–32 mm Hg); IOP subcompensation zone (33–39 mm Hg) and uncompensated IOP zone (≥40 mm Hg). The \"steps\" of the average values of rigidity, fluctuations, and the IOP ranges adequate to them do not intersect. The current value of the rigidity of the fibrous membrane and the IOP value calculated in youth make it possible to reliably attribute each healthy or glaucoma eye to its individual IOP zone.CONCLUSION. Rigidity of the fibrous membrane consistently determines the level of IOP (p>0.001), while the rigidity and fluctuation of the sclera directly influence its current level. The fundamental criteria — rigidity and fluctuation of the fibrous membrane of the eye — do not depend on the central corneal thickness and objectively determine the current functional state of the fibrous membrane. The ability to objectively and reliably determine whether a healthy or glaucoma eye belongs to its individual IOP zone is particularly important for the polyclinic network. The time such express diagnostics takes is 0.02 seconds.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"67 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120883692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving on to surgical stage of glaucoma treatment","authors":"V. Erichev, S. N. Basinsky, A. Kuroyedov","doi":"10.53432/2078-4104-2023-22-1-92-102","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-92-102","url":null,"abstract":"Making a decision about the need for surgical intervention in glaucoma patients is not easy, and the rationale for it involves a balanced approach based on numerous objective, as well as, unfortunately, subjective factors. Therapeutic approaches in modern glaucomatology have temporarily, and as it seems, for quite some time, have shifted towards active observational therapeutic strategy, which brought negative results expressed in deteriorating outcomes of surgical treatment. At the same time, it is obvious that not all indications for surgical treatment have the same \"weight\", which also determines the need for a differentiated approach. The discussion about the decisionmaking time for transition to surgical tactics of glaucoma treatment has been repeatedly discussed, is being discussed, and will continue to be discussed in the professional circles, with new arguments arising due to clarification of the pathophysiology of glaucomatous optic neuropathy, active use of interdisciplinary approaches, emergence of new tools, devices and technologies, coupled with improvement of surgical skills, increase in the life expectancy of the population, as well as the need for rational assessment of socio-economic resources of the state and the individual. This review describes the generalized experience and the authors' own point of view on this problem.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128542985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in target IOP values in glaucoma patients depending on the number of surgical interventions they underwent","authors":"M. Kats, A. Kuroyedov, M. A. Arkharov","doi":"10.53432/2078-4104-2023-22-1-55-65","DOIUrl":"https://doi.org/10.53432/2078-4104-2023-22-1-55-65","url":null,"abstract":"PURPOSE. To determine the optimal intraocular pressure (IOP) values that contribute to stabilization of the course of the disease in patients with different stages of primary open-angle glaucoma (POAG) before and after surgery, depending on the current state of ocular biomechanical parameters.METHODS. This analytical descriptive scientific-clinical study analyzes the results of diagnostic studies conducted in the period from 2019 to 2022. The final protocol included 137 patients (209 eyes) with different stages of POAG. Two groups of patients were identified: the main group (105 patients, 156 eyes) with POAG, and the control group (32 patients, 53 eyes) — healthy individuals and patients with an established diagnosis of cataract. All patients underwent a thorough ophthalmological examination, including routine as well as special methods such as ophthalmotonometry in six different ways, bi-directional pneumatic applanation of the cornea, measurement of central corneal thickness (CCT). Additional decrease of the IOP level depending on the characteristics of the fibrous membrane of the eye was calculated using a simple regression followed by an assessment of the quality of the constructed model according to the calculated coefficients of determination (r2).RESULTS. The IOP values and biomechanical parameters of the fibrous membrane of the eye were analyzed depending on the stage of glaucoma process and the absence or presence of a history of surgical interventions for glaucoma in patient’s anamnesis. Significant differences in the viscoelastic parameters of the fibrous membrane of the eye were revealed between patients who had not undergone surgical treatment and those who had undergone one or two surgeries. Algorithms were developed to determine specific correction coefficients in order to correctly interpret the results of tonometry, taking into account the biomechanical characteristics of the membranes of the eye, and differences in target IOP were determined for groups of patients with different stages of POAG before and after surgical treatment.CONCLUSION. The results of this study demonstrate that the changing characteristics of the fibrous membrane of the eye in patients with glaucoma associated with previous surgical treatment can significantly distort the interpretation of data obtained using the basic ophthalmic tonometry. The study also shows that when choosing a «safe» range of IOP levels in patients with POAG, it is necessary to take into account patient’s history of penetrating surgical interventions. Thus, in single-operated patients, an additional decrease in IOP is required, on average by 1.7 mm Hg, while in repeatedly operated patients — by almost 3 mm Hg.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114605831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors in the development of refractory primary open-angle glaucoma (part 1)","authors":"N. E. Fomin, A. Kuroyedov","doi":"10.53432/2078-4104-2022-21-4-79-88","DOIUrl":"https://doi.org/10.53432/2078-4104-2022-21-4-79-88","url":null,"abstract":"Primary open-angle glaucoma (POAG) is one of the most significant medico-social problems in the modern society. The development of its refractoriness aggravates the pathological process and inevitably leads to blindness. Despite the fact that this form accounts for up  to  80%  of all glaucoma cases, the problem of POAG refractoriness has not been considered in sufficient detail in either Russian or foreign sources. The article presents an overview of the main ophthalmic factors that contribute to changes in various structures of the eyeball and accelerate the formation of refractory forms of POAG. One of the reasons for that is a genetic predisposition to the  development of POAG.  It is worth noting that in 60% of patients with    a family history of glaucoma, the risk of developing POAG increases by 10 times (among the first-degree relatives).Additional factors in the development of the refractory form of POAG are the reactive syndrome and during laser surgery. It is important to emphasize that the risk of development and progression of POAG in patients with     a hereditary predisposition is much higher, while indicating a number of therapeutic measures may lead to drug resistance. Genotyping is a promising scientific and practical direction of research, allowing prediction of the pharmacological response to a particular drug and individual selection of the appropriate therapy according to the patient's genotype. This approach could help prevent a number of complications and improve the accuracy of disease prognosis.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115655621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}