The Influence of the Variability of the Profibrinolytic Response of the Blood Vessel Wall on the Effectiveness of Treatment of Primary Open-Angle Glaucoma. Part 3

Abstract

Purpose: study of the effect of dosed pneumatic vasocompression (DPVС) as part of complex therapy on functional indicators in patients with primary open-angle glaucoma (POAG) depending on the characteristics of the individual profibrinolytic response of the vascular wall. Patients and methods. An additional analysis of data that was obtained earlier in 20 patients of the main group with stage II POAG was performed. Patients of this group, along with conservative drug therapy at the inpatient stage, underwent a course of DPVС, including 4 sessions of pneumocompression of the upper extremities (see previously submitted to print work — Non-pharmacological enhancement of fibrinolysis in the treatment of primary open-angle glaucoma. Part 2). According to the results of assessing the severity of the profibrinolytic response to pneumocompression, patients were conditionally divided into two groups: 1st group — with a high response to a single external mechanical effect, documented by an increase (∆) of t-PA / PAI 1 ≥1.00 (Me 1.57; 95 % CI 1.12–3.83); 10 patients, and the 2nd group — with a low response with ∆t-PA / PAI 1 –0.37); also 10 patients. In the both groups, a comparative analysis of the hemostasis and fibrinolysis system indicators, as well as the functional parameters of the organ of vision, hydrodynamics and retinal sensitivity, was carried out. Results. It was revealed that in patients with a high response after external mechanical exposure there is an increase in t-PA level after 1 hour 1.88 times and after 24 hours 2.08 times from baseline (median). In contrast, in patients with low response, there was only a tendency for this indicator to increase after 1 hour (1.43 times, median) and return to baseline after 24 hours, which was not statistically significant. In patients with a high response to pneumocompression after the end of the course of complex therapy, the best results were observed, reflecting the indicators of hydrodynamics and photosensitivity of the retina. Conclusion. When selecting patients with POAG that require vasocompression, it is advisable, at the treatment course beginning, to evaluate the individual reaction of the wall of the blood vessels of the upper limb by changing the ratio of t-PA / PAI-1 before and 1 hour after the session. It is proposed to include DPVС in the composition of complex drug therapy for POAG in those cases when the ∆ ratio indicator t-PA / PAI-1 is equal to or more than 1.0.