What Are the Best Treatments for Open-Angle Glaucoma?

Open-angle glaucoma includes primary and secondary glaucoma. However, clinical open-angle glaucoma generally refers to primary open-angle glaucoma, that is, glaucomatous optic neuropathy and corresponding visual field defects may occur in the absence of obvious causes and anterior chamber angle is open, which may eventually lead to blindness .

Basic Information

English name: open-angleglaucoma
Visiting department: Ophthalmology

Multiple groups: Seniors
Common symptoms: blindness
Contagious: no

Causes of open-angle glaucoma

The cause of the disease is unknown. The reason for the increase in intraocular pressure is that the outflow of aqueous humor is blocked by the trabecular meshwork-Schlemm tube system. Some patients have a genetic disease tendency, such as TIGR gene, OPTN gene and so on. Some patients have a family history of glaucoma.

The main risk factors of the disease are increased intraocular pressure, but there are also other risk factors, such as reduced tolerance to intraocular pressure caused by optic nerve ischemia, etc., and thin corneal thickness. In the early stage, intraocular pressure may only show an increase in the fluctuation range. For example, the intraocular pressure may be high at some times, and the intraocular pressure may be normal at other times. A normal IOP measurement does not mean that there is no increase in IOP. It is necessary to further measure the IOP curve for 24 hours to understand the overall situation of IOP as much as possible. ^[7-9]

Open-angle glaucoma classification

The disease is closely related to intraocular pressure, which can be elevated or normal. According to whether the patient has elevated intraocular pressure, it is divided into "primary open-angle glaucoma high intraocular pressure type" and "normal intraocular glaucoma". ^[4-6]

Clinical manifestations of open-angle glaucoma

The most important clinical manifestations are glaucomatous optic neuropathy, which is mainly manifested by irregular loss of the disc along the optic disc, increased optic disc depression, retinal nerve fiber layer defects, superficial hemorrhage of the optic disc, changes in the movement of optic disc vessels, and atrophic choroidal retina atrophy Wait, the late optic disc atrophy is pale in color, and may be accompanied by a full-time optic disc choroidal retinal atrophy (glaucoma). Glaucomatous optic neuropathy will worsen with the worsening of the disease, and the harm caused will gradually reduce the visual field. The early manifestations were the paracentral dark spots and nasal steps within the center 300, which gradually developed into arched dark spots, circular dark spots, late tubular vision, and temporal lateral islands. Finally, the vision disappeared and became completely blind. Studies have shown that, if glaucoma is left untreated, the natural course of visual field damage to complete blindness is 21 to 25 mmHg, about 14.4 years, 25 to 30 mmHg, about 6.5 years, and 30 mmHg or more, about 2.9 years. ^[1-8]

Open-angle glaucoma

Because early lesions are mild and often difficult to diagnose, some fundus examination and image analysis systems can provide information and diagnostic evidence from different angles, such as: fundus camera, Heidelberg retinal tomography scanner (HRT), optical coherent retinal tomography scanner (OCT) , GDX glaucoma diagnostic instrument and so on. ^[10-12]

The visual field inspection method is a visual field meter. A computer-controlled fully automatic static visual field meter can detect early visual field defects through quantitative detection, and it can also regularly monitor the visual field for deterioration. In order to confirm visual field defect or visual field progress, multiple visual field examinations are necessary. ^[13-15]

Open-angle glaucoma diagnosis

Clinically based on intraocular pressure, glaucomatous optic neuropathy, and corresponding visual field defects, gonioscopy showed that the angle of the room was normally open, and the diagnosis could be determined after excluding other pathogenic factors. ^[9-18]

Differential diagnosis of open-angle glaucoma

The diseases that need to be identified mainly include chronic angle-closure glaucoma and secondary glaucoma (such as retrograde angle glaucoma and hormonal glaucoma). The identification is generally not difficult as long as it is collected based on the angle of view and history. ^[16]

Open-angle glaucoma treatment

There is no cure for radical cure. The most effective treatment is to stop or delay visual field deterioration by reducing intraocular pressure. Studies have shown that it may not be enough to lower the IOP to within the normal range (21mmHg). Instead, individual patients need to be set based on the patient's IOP, the severity and speed of visual field damage, the patient's age, and the contralateral eye. Safe "Target IOP". The treatment methods for reducing intraocular pressure include drug treatment (lowering intraocular pressure eye drops), laser trabeculoplasty, and filtering surgery. In general, early patients are suitable for conservative treatment with drugs and lasers. If the effect is not enough, surgical treatment is considered; late stage tends to be surgical treatment, except for special cases. IOPs are mainly prostaglandin derivatives (latanoprost, travoprost, bemeprost, etc.), adrenergic -receptor blockers (timolol maleate, Cartilolol hydrochloride, levobunolol hydrochloride, betaxolol hydrochloride, etc.), adrenergic 2 receptor agonist (bromonitine), carbonic anhydrase inhibitor (brinzamide, etc.) , Pseudocholine drugs (pilosphine), and so on. Laser treatment is best with selective laser trabeculoplasty. Filtration mainly includes trabeculectomy and non-penetrating trabeculectomy. Treatment emphasizes long-term and stable reduction of intraocular pressure, regular review and follow-up throughout life, timely adjustment of treatment plan, and maximum maintenance of visual function. ^[17-18]