THE NEW APPROACH IN DIAGNOSTIC AND EVALUATION OF SEVERITY RATE IN CASE OF PRIMARY OPEN-ANGLE GLAUCOMA: CHRONOBIOLOGICAL AND CLINICAL COOPERATION

O. Pirozhok and O. Mykytiuk

Department of Ophthalmology, Bukovinian State Medical Academy, Chernivtsy, Ukraine

We observed 119 patients (183 eyes) in groups formed according to data of circadian tonometry. ( individual and generalized schemes of circadian IOP-dynamics employed.). Control group had normal IOP standard chronogram with no specific subjective/objective clinical changes.

2. Glaucoma suspicious group: -VS  0.1-0.3 D lower. It pointed on 30% mesor increasing (from IOP basal level) and increase of amplitude fluctuations 10 mm. Hg. more.

-Visual fields narrowing from N-side (0, 45, 90 meridians) on 20-30 % corresponded acrophase shifting on 8.00 a.m. with IOP peak level at 8.00 a.m. and 5.00 p.m.

-Initial excavation of the optic disc combined with retinal angiosclerosis corresponded IOP peak at 11.00 p.m. with nighttime increasing tendency.

-If no specific clinical data and complaints were noted in presence of typical chronologic signs, glaucoma changes appeared in 6 months.

3. Glaucoma group was characterized by:

-Visual astenopy, gray optic disc- corresponded maximal IOP at period 5.00-8.00 p.m. with amplitude more 15/20 mm. Hg.

-Visual field defect from N-side, rainbow vision, front-seeing fog, scotomas – corresponded IOP peak level at 11.00 a.m.

-Iridal atrophy, gray optic disc with significant pathologic excavation and retinal vessels bending corresponded higher IOP level in the morning period.

Conclusions: 1. Proposed original schemes permit evaluation of circadian IOP dynamics using complaints and clinical data.

2. They are recommended for time selection for increasing IOP detection.

3. Therapeutic subdivision of patients into clinical groups should take into account circadian IOP dynamics.