The dissertation is devoted to the problem of optimization of diagnosis and treatment of patients with primary open-angle glaucoma with primary hypothyroidism by clinical substantiation of complex treatment, which includes hormone replacement therapy in combination with antihypertensive glaucoma therapy.
Hypothyroidism is a common abnormality with an incidence of 1-2%. According to various epidemiological studies, in some groups the prevalence of hypothyroidism reaches 10-12%. There is a strong association between thyroid disease and the risk of developing POAG. In hypothyroidism, the prevalence of POAG was 1.22%. The search for new ways to preserve visual functions in primary open-angle glaucoma is an extremely important problem of modern ophthalmology.
The development of new methods of pathogenic therapy of POAG in various forms of primary hypothyroidism and the feasibility of studying the effectiveness of a comprehensive method of treatment of patients with POAG with PSH is an urgent task of modern ophthalmology.
To assess the features of the course of POAG in patients with various forms of primary hypothyroidism, to develop and determine the effectiveness of a comprehensive method of treatment of this category of patients, the study involved 170 patients (170 eyes) with POAG I-III stages, 94 women (55.3%) and 76 men (44.7%), the age of patients ranged from 40 to 72 years, who were divided into 4 observation groups comparable by sex and age. The first group (control) consisted of 50 patients (50 eyes) with POAG without hypothyroidism (HT). The second group involved 40 patients (40 eyes) with POAG accompanied by primary subclinical hypothyroidism (PSH), the third group comprised 40 patients (40 eyes) with POAG in combination with primary clinical hypothyroidism (PCH), who were treated in the endocrinology department. The fourth observation group included 40 patients (40 eyes) with POAG in combination with PSH was divided into 2 subgroups: 1st subgroup of 20 patients (20 eyes) with blood TSH levels between 5 and 10 IU/l with concomitant dyslipidemia who received hormone replacement therapy and subgroup 2 of 20 patients (20 eyes) with a level of TSH in the blood between 5 and 10 IU/l, who did not receive hormone replacement therapy at the decision of the endocrinologist.
All patients underwent ophthalmological examinations (visometry, ophthalmoscopy, biomicroscopy, pneumotonometry, ultrasonic keratopachymetry, gonioscopy, autokeratorefractometry, Humphrey computed perimetry, optical coherence tomography (OCT), including the assessment of clinical, functional and morphometric parameters of the visual organ, namely visual acuity, IOP level, stage of glaucoma process, perimetric indicators of MD and PSD, morphometric indicators of OCT – Area cup/disc ratio, RNFL and Vrim.
The results of the study revealed differences in the course of POAG in patients with PSH (group II) and PCH (group III) compared with controls (group I).
In patients with POAG without HT, with PSH and PCH, the largest percentage were patients with visual acuity (0.8-1.0), which was 90%, 72.5% and 70%, respectively (p <0.05). Compared with patients without HT with PSH and PCH, there was a decrease in the percentage of patients with retinal sensitivity of ≤-6 dB by 40% and 45%, as well as an increase in the percentage of patients with retinal sensitivity of ≥-12dB by 4.2 and 4.6 times; reduction in the percentage of patients with PSD <4.5 by 40% with PSH and by 45% with PCH; increase in the percentage of patients with PSD> 7.5 by 4.2 and 4.6 times, respectively. Patients with PCH were found to have an (p <0.05) increase in Area cup/disc ratio by 4%, a decrease in Vrim by 7% compared with the control group.
Evaluation of the impact of hormone replacement therapy in the complex treatment of primary open-angle glaucoma showed that administration of hormone replacement therapy in patients with POAG with PSH slowed the progression of GON, affecting the improvement of visual acuity (p> 0.05), leaving twice as many patients with stage I POAG (ϕ= 1.7; p <0.05) and reducing by 3.5 times the number of patients with stage III POAG (ϕ = 2.0; p <0.05) and allows to normalize IOP in 90% of patients with antihypertensive drugs, in 10% with the use of laser and surgical techniques (p <0.05). Effective impact on perimetric and morphometric indicators results in an increase in MD indicator by 10% and 26%, and also to reduce PSD indicator by 25% and 29%, Area cup/disc ratio by 11% and 19%, to increase RNFL indicator by 5% and 7% and Vrim by 7% and 25% after 6 months and 1 year of follow-up, respectively (p <0.05).
