Primary glaucoma in patients with various somatic diseases: main features of monitoring and disease course
Alexeev V.N., Zaporozhetc L.A., Rindgibal Al-Maisam

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia,
Regional hospital of Saint-Petersburg, Russia

Treatment of primary glaucoma is determined by a number of factors: the appropriate diagnosis, adequate treatment regimen, competent medical observation, as well as a number of social and economic reasons. Strict implementation of the leading clinics recommendations, aimed at correction of intraocular pressure and neuroprotective treatment of the optic nerve can not guarantee long-term maintenance of visual function in patients with primary glaucoma.
Purpose: In this study the dependence of decrease of visual function in the presence of concomitant somatic diseases - hypertension, vascular encephalopathy, diabetes mellitus, autoimmune thyroiditis was evaluated.
Methods: To determine the peculiarities of the glaucoma process in patients with various somatic diseases – hypertension, dyscirculatory encephalopathy, diabetes mellitus, autoimmune thyroiditis. A database analysis of 2250 patients was done. Selected group of patients with primary open-angle glaucoma, consisting of 174 patients (348 eyes, including eyes with terminal glaucoma). The diagnosis of glaucoma was made on the basis of the data analysis of biomicroscopy, оphthalmoscope, Heidelberg retinal tomography, optical coherence tomography, kinetic and static perimetry, tonometry and diagnostic tests. All patients of this group had concomitant somatic pathology. In each patient, in accordance with the objectives of the study, there was only one set of disease (hypertension, encephalopathy, diabetes or autoimmune thyroiditis). The choice of somatic pathology was determined by the prevalence of this disease in the population. Simultaneously created the second, control, group of patients, which also included 174 patients (348 eyes). Patients from the control group did not suffer from glaucoma, but had the concomitant somatic pathology.
Results: The analysis of the distribution of glaucoma in patients with concomitant somatic pathology according to age allowed us to identify groups at risk of progression of glaucoma. Most at risk of progression of glaucoma was the group of patients older than 70 years, suffering from hypertension (50,3%) and dyscirculatory encephalopathy (48,5 %). High risk of progression of glaucoma was in patients from 40 to 49 years of age with diabetes (29,1%) and autoimmune tireo-dieth also (16,6 %). Patients adjacent age groups had a lower incidence indicators of glaucoma depending on the age and presence of concomitant somatic pathology.
Сonclusions: The analysis of the general somatic state of patients with primary glaucoma showed a significant relationship between the prevalence of hypertension, dyscirculatory encephalopathy, diabetes mellitus, autoimmune thyroiditis and primary glaucoma. Most at risk of progression of glaucoma was the group of patients 60 years of age, have a history of diabetes mellitus and autoimmune thyroiditis, and the group of patients older than 60 years with comorbidities – hypertension and dyscirculatory encephalopathy. It is recommended to take into account this feature of primary glaucoma in the prolonged course of medical observation of patients and monitor the somatic status of the patients in cooperation with the relevant experts.

Keywords: primary glaucoma, hypertension, diabetes, encephalopathy, autoimmune thyroiditis, risk groups, dynamic monitoring.

For citation: Alexeev V.N., Zaporozhetc L.A., Rindgibal Al-Maisam Primary glaucoma in patients with various somatic diseases: main features of monitoring and disease course // RMJ. Clinical ophthalmology. 2016. № 2. P. 79–82.