Socioeconomics of long‑term glaucoma therapy in India.

Purpose: To determine the socioeconomic impact of long‑term glaucoma therapy. Materials and Methods: One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side‑effects was administered. Results: The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/‑ (range: Rs. 500/‑ to Rs. 50,000/‑) with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti‑glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001). The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001). Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6–96 h/month). About 2.7% experienced systemic side‑effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment. Conclusions: Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.

Glaucoma crónico de ángulo estrecho en gemelas dicigóticas / Chronic narrow-angle glaucoma found in dizygotic twins

Caso clínico: se informa el caso de una pareja de gemelas dicigóticas con diagnóstico de glaucoma crónico de ángulo estrecho en 2004, cuyol padre murió ciego; una hija de una de ellas fue diagnosticada posteriormente como afectada de glaucoma crónico de ángulo abierto. Se determinó la cigosidad de las gemelas mediante protocolo establecido al respecto. En los 4 ojos de las pacientes se determinaron presiones intraoculares por aplanación en cifras que fluctuaban entre 26-32 mmHg, cámaras anteriores y ángulos camerulares estrechos, perimetrías computarizadas tubulares en 3 ojos respetando los 5° centrales y en otro tubular que respetaba los 10° centrales con atrofias ópticas en evolución en los 4 ojos. Se efectuó trabeculectomía bilateral en ambas pacientes y se mantuvo el control de su enfermedad glaucomatosa. Conclusiones: se plantea la necesidad de la búsqueda de otros afectados en un núcleo familiar donde se diagnostiquen pacientes con glaucoma crónico de ángulo estrecho

Clinical case: here is the case of a dizygotic twin pair diagnosed with chronic narrow-angle glaucoma in 2994. Their father had died blind and a daughter of one of them was later diagnosed as a chronic open-angle glaucoma patient. A specific protocol allowed determining the zygocity of the twins. The intraocular pressures in the four eyes of the patients were measured with applanation tonometry and ranged 26-32 mmHg, narrow anterior chambers and camerular angles, computerized tubular perimetries in three eyes around central 5° and another tubular perimetry of central 10°, with developing atrophies in the four eyes. Both patients underwent bilateral trabeculectomy and the control over their glaucoma disease was kept. Conclusions: It is necessary to look for other people affected in a family setting where there exists diagnosis of chronic narrow-angle glaucoma

Caracterización del glaucoma crónico simple en un área de salud del Municipio Especial Isla de la Juventud / Characterization of simple chronic glaucoma in a health area from the Isla de la Juventud Special Municipality

Objetivo: identificar las características clínico-epidemiológicas del glaucoma crónico simple en personas mayores de 40 años, en el área de salud Dr. Juan Manuel Páez Inchausti, Nueva Gerona, Isla de la Juventud. Métodos: se realizó un estudio descriptivo y transversal durante el segundo semestre de 2008, en una de las dos áreas de salud que cubren la atención primaria de la población de Nueva Gerona. Se chequeó el 98,8 por ciento de la población mayor de 15 años y, después de aplicados los criterios de selección, fueron considerados 90 pacientes con diagnóstico previo de la enfermedad, de acuerdo con los parámetros estipulados para el seguimiento de esta. Se analizaron las variables edad, sexo, color de la piel, relación presión intraocular-excavación papilar, alteraciones campimétricas, síntomas y signos, antecedentes familiares de la enfermedad según grado de parentesco y enfermedades sistémicas y oculares asociadas con enfoque de riesgo. El procesamiento de la información se realizó mediante el método porcentual. Resultados: se reportó mayor número de pacientes entre 60 y 69 años (24,4 por ciento), de mujeres (53,3 por ciento) y de piel blanca (38,9 por ciento). Los rangos predominantes de valores de presión intraocular y de excavación papilar fueron entre 16 y 21 mmHg (40,0 por ciento), y entre 0,4 y 0,7 (37,8 por ciento); en la relación entre ambas variables predominaron ambos rangos (16,7 por ciento). Conclusiones: Las características clínico-epidemiológicas más relevantes del glaucoma crónico simple en los pacientes estudiados no difieren, en general, de lo reportado en la literatura, con excepción del predominio en mujeres de piel blanca, lo que puede deberse a la conformación de la muestra. La información obtenida del presente estudio debe considerarse parte del registro inicial de las características de la enfermedad en Cuba

Objective: To identify the clinical-epidemiological features of simple chronic glaucoma in persons aged over 40 in the "Dr. Juan Manuel Pßez Inchausti" health area, Nueva Gerona, Isla de la Juventud municipality. Methods: A cross-sectional study was conducted during the second trimester of 2008 in one the health area covering the primary care of inhabitants of Nueva Gerona. The 98.8 percent of patients aged over 15 was examined and after applications of selection criteria, 90 patients with a diagnosis previous to disease were considered according to the stipulated parameters for its follow-up. Following variables were analyzed: age, sex, skin color, relation intraocular-papillary excavation, campimetry alterations, symptoms and signs, family disease backgrounds according to the relationship degree and systemic and ocular diseases associated with risk approach. The information processing was made by conceptual method. Results: There was more reported patients aged between 60 and 69 (24.4 percent), of women (53.3 percent) and of white race (38.9 percent). The predominant values ranks of intraocular pressure and of papillary excavation were between 16 and 21 mmHg (40.0 percent), between 0.4 and 0.7 (37.8 percent); in relation between both variables the two ranks predominate (16.7 percent). Conclusions: The more relevant clinical-epidemiological features of the simple chronic glaucoma in study patients not differing in general from that reported in literature, except the white race women predominance maybe due to sample conformation. The information obtained from present study must to be considered as part of initial registry of disease features in Cuba

Individualización de pacientes con baja visión en el Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso / Individualization of low vision patients in Dr Juan Bruno Zayas Alfonso Teaching General Hospital Ophthalmologic Center

Se efectuó un estudio descriptivo y transversal de 73 pacientes con baja visión, que asistieron a la consulta del Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde julio hasta diciembre del 2009, a fin de describir algunas características clínicas y demográficas. La degeneración macular asociada a la edad primó en más de 25,0 por ciento de los integrantes de la casuística, seguida por el glaucoma crónico simple y la miopía degenerativa y, según lugar de procedencia, los pertenecientes al municipio de Santiago de Cuba representaron 73,0 por ciento del total. Se logró rehabilitar a 89,0 por cientode los pacientes examinados y tratados

A descriptive and cross sectional study of 73 patients with low vision who visited the Ophthalmologic Center at Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from July to December 2009 in order to describe some clinical and demographic characteristics. Macular degeneration associated with age prevailed in more than the 25,0 per cent of the case material, followed by simple chronic glaucoma and degenerative myopia and, according to origin place, those belonging to Santiago de Cuba municipality represented 73,0 per cent of the total. It was possible to rehabilitate the 89,0 per cent of the examined and treated patients

Expression of Nitric Oxide Synthase Isoforms in a Rat Model of Chronic Glaucoma

PURPOSE: This study investigated the expression of three isoforms of nitric oxide synthase (NOS): neuronal (nNOS), inducible (iNOS), and endothelial (eNOS) in an experimental rat model of chronic glaucoma. The aim was to research the role of nitric oxide (NO) as a neurotoxic molecule in connection with damage to and the degeneration of retinal ganglion cells in glaucoma. METHODS: Retinal tissues were obtained after inducing chronic elevation of intraocular pressure by cauterization of episcleral vessels. We then performed quantification and localization of NOS isoforms through western blot and immuno-fluorescence staining of the tissues. RESULTS: The expression of nNOS and iNOS increased significantly but that of eNOS did not. nNOS expressed in the amacrine and displaced amacrine cell of the normal retinal tissue, as well as in retinal ganglion cells in the experimental group. iNOS that expressed in the microglia of the normal retinal tissue was also expressed in the cell thought to be an astrocyte or Muller cell end-feet in the experimental group. Administration of L-NAME (NG-nitro-L-arginine-methyl-esther), a non-specific NOS inhibitor, tended to reduce retinal ganglion cell loss, but this result was without statistical significance. CONCLUSIONS: These results showed that the cytotoxicity of excessive NO took part in retinal ganglion cell loss in glaucoma, and the expression of nNOS in retinal ganglion cells suggests that it may play an important role in the selective death of the retinal ganglion cell.

EFFECTS OF TETRAMETHYLPYRAZINE ON RETINA OF RABBITS WITHEXPERIMENTAL GLAUCOMA / 药物分析学报

Objective To observe the effects of tetramethyipyrazine(TMP) on retina to find out whether it can protect retina from glaucomatous damage. Methods Twenty-four rabbits were randomly divided into four groups. One eye of each rabbit was model eye induced by 2％ methylcellulous, and the other was control eye. Normal saline, TMP, timolol and a combination of timolol and TMP were administrated to group A, B, C and D respectively. At the end of 4th week, eyes were excavated for light and electron microscopic study. Results The numbers of ganglion cells (P ＜0. 01) and bipolar cells (P ＜0. 01) in model eye were different significantly between group A and B. In group A, the model eye ganglion cells were karyopyknosis, chromatin margination and nuclear membrane rupture; some in ner nuclear cells dcveloped marked lytic changes; outer segment appeared disorganized; but group B changed slight ly. Conclusion The results suggest that TMP may protect retina from glaucomatous damage.