Фармакотерапия первичной хронической глаукомы у пациентов с сахарным диабетом в зависимости от состояния макулярной области

Background: In diabetic patients with glaucoma, individualized pharmacotherapy of glaucoma is needed.  Aim: To assess the effects of topographic morphometric characteristics of macular region and presence of concomitant diseases on visual acuity in patients with diabetes mellitus and glaucoma or ocular hypertension in order to provide optimal drug treatment.  Materials and methods: 178 patients with diabetes and glaucoma or ocular hypertension were examined.  Results: Background somatic pathology was as follows: arterial hypertension in 92.7% of the patients, ischemic heart disease in 36.2%, dyscirculatory encephalopathy in 96.1%, bronchial asthma in 5.6%, cervical osteochondrosis in 20.2%. 86.7% of the patients had primary chronic open-angle glaucoma, 1.1% – narrow-angle glaucoma, 1.1% – low pressure glaucoma, and 2.2% – secondary glaucoma. Significant diabetic macular edema was found in 85% of cases. Thickness of parafoveola was significantly negatively correlated with corrected visual acuity. Serous retinal detachment was demonstrated in 27.7% of cases, detachment of epiretinal membrane – in 41.7%, cystic changes – in 50% of the patients.  Conclusion: In patients with diabetes and glaucoma, hypotensive therapy with prostaglandins may be contraindicated due to background changes of macular region.