Akių hipertenzija ir glaukomų progresavimo rizika

Abstract

Pastarųjų metų klinikiniai tyrimai rodo, kad akių hipertenzija yra 10–15 kartų dažnesnė nei pirminė atviro kampo glaukoma. Pacientus, kuriems nustatyta akių hipertenzija, reikėtų sekti atidžiau dėl galimo glaukomos išsivystymo, ypač tuos, kurių plonas centrinis ragenos storis. OHTS (Ocular hypertension Treatment Study) duomenimis, yra 10% rizika, kad akių hipertenzija per 5 metus progresuos į glaukomą. Rizika sumažėtų, efektyviai sumažinus akispūdį. Tačiau žinome, kad daliai pacientų negydoma hipertenzija neprogresuos iki glaukomos. Kaip atskirti, kuriuos pacientus intensyviai gydyti, o kuriuos – tik sekti? Nauja klinikinė akių hipertenzijos studija DIGS (Diagnostic Innovations in Glaucoma Study) pasiūlė matematinį individualios akių hipertenzijos progresavimo į glaukomą rizikos įvertinimo modelį, padedantį pagal rizikos veiksnius nustatyti glaukomos išsivystymo per 5 metus tikimybę. The course of glaucoma disease progression varies significantly between individuals. Some patients are at risk for rapid and sight threatening progression while others may live many years without any apparent symptoms. Findings form recent randomised clinical trials have discovered risk factors for disease progression and determined patients at risk who have to be treated earlier and more aggressively. Ocular hypertension is a term used to describe individuals who should be observed more closely than the general population for the onset of glaucoma. Ocular hypertension is 10-15 times more likely to occur than primary open-angle glaucoma. That means that out of every 100 people older than 40 years about 10 will have pressures higher than 21 mm Hg, but only 1 of those people will have glaucoma. Over a 5-year period, several studies have shown the incidence of glaucomatous damage in people with ocular hypertension to be about 2.6-3% for intraocular pressures of 21-25 mm Hg, 12- 26% for intraocular pressures of 26-30 mm Hg, and approximately 42% for those higher than 30 mm Hg. Recent data from the Ocular Hypertension Treatment Study have shown that patients with ocular hypertension have an average estimated risk of 10% of developing glaucoma over 5 years. This risk may be decreased to 5% (a 50% decrease in risk) if eye pressure is lowered by medications or laser surgery. However, the risk may become even less than 1% per year because of significantly improved techniques for detecting glaucomatous damage. New clinical trials describe how to detect patients at risk and how to predict disease progression.