Eye diseases. Principles of glaucoma treatment (most important)

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Eye diseases. Principles of glaucoma treatment (most important)

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48. Principles of glaucoma treatment

In the case of developing a drug treatment regimen for a patient with glaucoma, an observation period is established (at least two to three weeks), after which it is necessary to use the drug. In the future, the effectiveness of treatment is monitored once every 1 months.

Treatment of patients with primary glaucoma usually begins with the administration of instillations of solutions of cholinomimetic agents, most often a 1% solution of pilocarpine hydrochloride 23 times a day. If normalization of intraocular pressure is not observed, instillation of a 2% solution of pilocarpine is prescribed 3 times a day. These drugs are used 3 times a day. Pilocarpine hydrochloride 12 times daily and 2% pilocarpine ointment at night are also prescribed in ophthalmic film.

Other cholinomimetic agents (13% solutions of carbacholine or 25% solutions of aceclidine) are used much less frequently. If cholinomimetic drugs are insufficiently effective, one of the miotic agents with anticholinesterase action (prozerin, phosphakol, armin, tosmilen) is additionally prescribed. The frequency of instillation of these drugs is no more than twice a day. For patients with open-angle glaucoma with low or normal blood pressure and insufficient effectiveness of pilocarpine hydrochloride, instillations of 12% solutions of adrenaline hydrotartrate, dipivalyl epinephrine, isoptoepinal are added or adrenopilocarpine is prescribed 23 times a day.

It is possible to use instillations of a 0,5% solution of clonidine (hemitone). The hypotensive effect of clonidine leads to inhibition of aqueous humor secretion, as well as improvement of its outflow. The effectiveness of treatment is monitored 23 times a month.

β-adrenergic blocking agents are also used in the form of eye drops (1% anaprilin, 1% propranolol, 0,25-0,5% optimol). In case of insufficient effectiveness of local antihypertensive therapy for open-angle glaucoma, it is supplemented with short-term prescription of general antihypertensive drugs: carbonic anhydrase inhibitors (diamox, diacarb), osmotic (glycerol) and neuroleptic drugs (aminazine). The main indications for surgery are a persistent and significant increase in intraocular pressure, despite the use of various antihypertensive drugs; progressive deterioration of the visual field; negative dynamics of clinical data (condition of the iris, anterior chamber angle, optic nerve).

In recent years, laser methods have been used to treat primary glaucoma. The most effective in the drug treatment of angle-closure glaucoma are miotic drugs, mainly cholinomimetic drugs (pilocarpine, carbacholine, aceclidine). It is also possible to prescribe a 0,250,5% solution of timolol. In this form of glaucoma, adrenomimetic drugs (adrenaline, fethanol, clonidine) are also contraindicated. General agents for reducing intraocular pressure include diacarb and glycerol used orally.

With insufficient drug therapy, surgical and laser treatment is also used.

Author: Shilnikov L.V.

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