Managing Patients With Decompensed Advanced and Terminal Stage Glaucoma: Ophthalmogerontological Aspects

Relevance. The projected increase in the number of patients with glaucoma, late detection of the disease at an advanced stage with significant irreversible loss of visual function, leads to an expected rise in the number of patients with sensory deficits and subsequent disability. Considering the stage of the disease, the need to preserve residual visual function and reduce the frequency of instillations to improve the quality of life for such patients a special minimally invasive and highly effective approach to treatment is required. A crucial factor to consider is the evaluation of anesthesia risk, which involves factoring in comorbid conditions, a complex medical background, and potential interactions between different medications and the primary treatment.

Aim. To determine the efficacy of transscleral laser cyclocoagulation in older patients suffering from decompensated advanced and terminal glaucoma, and to evaluate its impact on their quality of life.

Materials and methods. The study included patients over 65 with decompensated advanced and terminal stages of glaucoma from the Ophthalmology Department of the War Veterans Hospital No. 2. Before the surgery, all patients received maximally tolerated hypotensive treatment. The surgical treatment, consisting of transscleral laser cyclocoagulation using a diode laser (wavelength 810 nm) with the Alcom Medika ALOD-01 device, was performed under local retrobulbar anesthesia (2% lidocaine solution, 4 ml). The average duration of the surgery was 10 minutes. The efficacy of the treatment was assessed based on the reduction in intraocular pressure (IOP), decreased frequency of instillations, perimetry results (kinetic perimetry before and 2 days after the surgery), and changes n visual function. Intraocular pressure measurements were taken on the 1st and 2nd days after the surgery, at 2 weeks, and then at 1 and 2 months postoperatively. During the three weeks following the laser intervention, no prostaglandin analogs were instilled in the operated eye.

Results. In all patients enrolled in the study, a reduction in intraocular pressure was observed to 40% on the first day, 60% on the second day, and 70% by the second week compared to the baseline level. At the end of the treatment, the frequency of instillations was reduced to 1–3 drops per day for all patients. Patients subjectively reported an improvement in visual function and pain relief. According to visual acuity measurements, an improvement of 1–2 lines on the eye chart was observed on average in patients with advanced glaucoma (80% of the examined patients). When assessing the results of perimetry, expansion of the peripheral visual field was observed in 80% of the examined patients or preservation of the visual field at the same level in 20% of the examined patients with advanced glaucoma. The level of intraocular pressure and improvement in visual function remained stable in 85% of the patients at the 2-month follow-up.

Conclusions. Surgical treatment using local anesthesia, minimal tissue trauma to the eye, and high efficacy in reducing intraocular pressure, improving visual function, and having a short rehabilitation period allow us to consider transscleral laser cyclocoagulation as the treatment of choice for older patients with decompensated advanced and terminal stages of glaucoma.