The profile of patients with secondary glaucoma: results of a multicenter study

PURPOSE . To determine the clinical and epidemiological characteristics of patients with various forms of secondary glaucoma (SG) for prediction of its prevalence, assessment of the effectiveness of treatment strategies, and production of a model of a typical patient profile. METHODS . This selective combined observational study was carried out in 24 ophthalmology departments across three countries from January to May 2024. A total of 409 patients with SG (409 eyes; 213 women, 196 men) aged 66 (57; 74) years were included. Study patients were divided into 5 main groups in accordance with the form of SG: neovascular secondary to diabetic retinopathy — 58 eyes (14.2%); post-thrombotic neovascular — 83 eyes (20.3%); postoperative (after posterior segment surgery) — 97 eyes (23.8%); uveal — 83 eyes (20.3%); and phacogenic — 88 eyes (21.4%). RESULTS . In most cases (66.7%), SG was diagnosed at advanced or terminal stages, which corresponded to higher intraocular pressure (IOP) levels. The median IOP was 32 (26; 39) mm Hg. The eyes were blind in 57.9% of cases. The proportion of patients with SG hospitalized or examined on outpatient consultation ranged from 0.2% to 7% (mean 1.8%) of the total number of patients per year. Uveal and postoperative SG were more common in younger patients, while neovascular and phacogenic SG were more prevalent in older individuals. Topical treatment for IOP included beta-blockers in 75.1% of cases, carbonic anhydrase inhibitors in 79.0%, and prostaglandin analogues in 30.1%. Combination therapy was prescribed in 48.2% of cases. Surgical treatment was performed in 355 (86.8%) patients. The most frequently used surgical techniques were vitrectomy (24.9%), phacoemulsification (23.9%), and laser cyclocoagulation (11.5%), they were accompanied by a significant number of postoperative complications (36.9%). CONCLUSION . Secondary glaucoma can have different forms, necessitating further investigation and potential revision of the current classification system. The disease is characterized by rapid progression and pronounced resistance even to aggressive treatment strategies, its management involves a variety of surgical approaches.