Investigation on anxiety, depression and sleep quality in primary glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the anxiety, depression and sleep status of patients with primary angle-closure glaucoma(PACG)and primary open angle glaucoma(POAG).<p>METHODS: Retrospective clinical study. The Anxiety Self-Rating Scale(SAS), Depression Self-Rating Scale(SDS)and Pittsburgh Sleep Quality Index(PSQI)were used to evaluate 60 patients with primary glaucoma(30 PACG, 30 POAG)diagnosed in the department of ophthalmology in our hospital during the period from June 2019 to December 2020 and 30 healthy adults from the physical examination department of our hospital as a control group. The scores of anxiety, depression and sleep quality in the three groups were compared.<p>RESULTS: The scores of SAS, SDS and PSQI in PACG and POAG groups(48.40±9.302, 53.40±8.625, 9.57±2.861; 42.57±9.684, 48.80±10.320, 7.23±2.223)were significantly higher than those in control group(37.03±6.805, 38.63±7.881, 4.87±2.688)(<i>P</i><0.05). The scores of SAS and PSQI in PACG group were higher than those in POAG group(all <i>P</i><0.05). With SAS≥45, SDS≥50 and PSQI>7, the positive rates of anxiety, depression and insomnia in the PACG group(77%, 73%, 70%)were higher than those in the POAG group(43%, 40%, 37%)and the control group(13%, 10%, 20%)(<i>P</i><0.05).<p>CONCLUSION: Patients with PACG has more severe anxiety, depression and insomnia than POAG, so necessary psychological intervention should be given.

Application value of serum PEDF, FGF19 and β-EP in the diagnosis and severity assessment of primary glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the application value of serum pigment epithelial derived factors(PEDF), fibroblast growth factor 19(FGF19)and β-endorphin(β-EP)in the diagnosis and severity assessment of primary glaucoma. <p>METHODS: A total of 102 patients with primary glaucoma in the hospital were enrolled as study group between February 2018 and February 2020, while other 102 healthy controls during the same period were enrolled as control group. The levels of peripheral serum PEDF, FGF19 and β-EP were compared between the two groups. And their diagnostic value for primary glaucoma was analyzed. The study group was divided into severe and non-severe groups according to the diagnostic criteria for severe primary glaucoma. The levels of peripheral serum PEDF, FGF19 and β-EP were compared between severe group and non-severe group. And their evaluation value for disease severity was analyzed. The risk factors of disease severity were analyzed by multivariate Logistic regression analysis. <p>RESULTS: The level of serum PEDF in study group was significantly lower than that in control group, while levels of FGF19 and β-EP were significantly higher than those in control group(<i>P</i><0.001). AUC values of PEDF, FGF19 and β-EP levels in the diagnosis of primary glaucoma were 0.695, 0.754 and 0.768, respectively. The level of serum PEDF in severe group was significantly lower than that in non-severe group(<i>P</i><0.001), while levels of FGF19 and β-EP were significantly higher than those in non-severe group(<i>P</i><0.001). <i>AUC</i>values of PEDF, FGF19 and β-EP levels in assessing the severity of primary glaucoma were 0.731, 0.709 and 0.685, respectively. PEDF lower than 9.66pg/mL, FGF19 higher than 143.75ng/L and β-EP higher than 106.27ng/L were independent influencing factors of severe primary glaucoma(<i>OR</i>=2.280, 1.570, 1.413, all <i>P</i><0.05). <p>CONCLUSION: FGF19 and β-EP are of auxiliary diagnostic value in primary glaucoma, while PEDF and FGF19 are of evaluation value in disease severity. PEDF lower than 9.66pg/mL, FGF19 higher than 143.75ng/L and β-EP higher than 106.27ng/L are independent influencing factors of severe primary glaucoma.

Avaliação econômica do glaucoma primário de ângulo aberto / Economic evaluation of primary open-angle glaucoma

Resumo Objetivo: Avaliar a relação custo-utilidade do tratamento inicial com laser ou medicamentos do glaucoma primário de ângulo aberto (GPAA) no Brasil, considerando de um lado os custos totais e de outro lado o impacto na qualidade de vida dos pacientes. Métodos: O estudo foi realizado com base em um modelo de Markov, onde uma coorte teórica de portadores de GPAA em estágio inicial foi gerada. Os parâmetros usados no modelo foram obtidos na literatura e incluíram: custos médicos diretos (consultas, exames, tratamento); custos não médicos diretos (gasto com hospedagem, transporte, alimentação, acompanhante); custos indiretos (relacionados à incapacidade para o trabalho); valores de utilidade (qualidade de vida medida em QALY - quality-adjusted life year); e probabilidade de transição entre os estágios de saúde. Três estratégias de tratamento foram testadas no modelo: (1) sem tratamento; (2) tratamento inicial com colírios; (3) tratamento inicial com trabeculoplastia a laser. A medida de desfecho foi a razão de custo-utilidade incremental (RCUI). A robustez do modelo foi testada através de análise de sensibilidade. Resultados: As estratégias (2) e (3) de tratamento inicial do GPAA geraram ganhos em qualidade de vida em relação à (1) no Brasil. Iniciar o tratamento com laser gerou ganho médio de 1 QALY, enquanto que com medicamentos propiciou um ganho de 2 QALYs em média. Dentre as três estratégias testadas, a estratégia (2) foi a custo-efetiva e foi dominante sobre as demais, pois foi ao mesmo tempo a mais barata e a mais efetiva. Conclusão: Tanto a trabeculoplastia a laser quanto os medicamentos como tratamentos primários do GPAA inicial geraram ganhos significativos de qualidade de vida. A estratégia de se iniciar o tratamento com medicações foi custo-efetiva, quando se considera os custos totais. A alternativa de tratamento inicial através de trabeculoplastia a laser não foi custo-efetiva.

Abstract Objective: To evaluate the cost-utility relation of the initial treatment with laser or primary open-angle glaucoma medications (PLA) in Brazil, considering on the one hand the total costs and on the other side the impact on patients' quality of life. Methods: The study was performed based on a Markov model, where a theoretical cohort of early-stage GPAA carriers was generated. The parameters used in the model were obtained in the literature and included: direct medical costs (consultations, examinations, treatment); direct non-medical costs (accommodation, transportation, meals, companions); indirect costs (related to incapacity for work); utility values (quality of life measured in QALY - quality-adjusted life year); and probability of transition between stages of health. Three treatment strategies were tested in the model: (1) without treatment; (2) initial treatment with eye drops; (3) initial treatment with laser trabeculoplasty. The measure of outcome was the incremental cost-utility ratio (RCUI). The robustness of the model was tested through sensitivity analysis. Results: The strategies (2) and (3) of the initial treatment of POAG generated gains in quality of life in relation to (1) in Brazil. Initiating the laser treatment generated an average gain of 1 QALY, whereas with medication it gave a gain of 2 QALYs on average. Among the three strategies tested, strategy (2) was cost-effective and was dominant over the other strategies, since it was at the same time the cheapest and the most effective strategy. Conclusion: Both laser trabeculoplasty and medications as primary treatments of early-stage POAG have generated significant gains in quality of life. The strategy of starting treatment with medications was cost-effective, whereas laser trabeculoplasty strategy was not cost-effective, when non-medical costs (direct and indirect) are included.

Etiology and Management of Referred Patients with Intraocular Pressure Elevation

PURPOSE: To investigate the underlying causes and clinical characteristics of patients referred with intraocular pressure (IOP) elevation. METHODS: We retrospectively reviewed the medical records of patients who were referred with IOP elevation from July 2016 to July 2017. Patients with baseline IOP ≥ 22 mmHg and those who were treated and followed up for 6 months were included. The prevalence rates of the underlying diseases that caused IOP elevation were evaluated and the clinical characteristics were compared between patients with primary and secondary glaucoma. RESULTS: A total of 127 patients were included (mean age, 59.3 ± 16.8 years; baseline IOP, 31.7 ± 10.5 mmHg). Among the study participants, 22.0%, 31.5%, and 46.5% had been diagnosed with ocular hypertension, primary glaucoma, and secondary glaucoma, respectively. Among the causes of IOP elevation, open-angle glaucoma (20.5%) had the highest prevalence rate among those with primary glaucoma and inflammation-related glaucoma (12.6%) was the most prevalent cause among those with secondary glaucoma. In a comparison between patients with primary and secondary glaucoma, the percentage of IOP reduction was not significantly different at 6 months after treatment (52.1% vs. 53.9%, p = 0.603). However, the rate of patients treated with drugs other than IOP lowering agents or who underwent surgery was significantly higher in the secondary glaucoma group compared with the primary glaucoma group (all p < 0.05). At 6-month follow-up, the secondary glaucoma group showed significantly higher improvement rates of visual acuity (p = 0.004), but had a larger proportion of patients with a visual acuity of less than or equal to finger count (p = 0.027). CONCLUSIONS: Treatment and visual outcome can vary depending on the underlying cause of IOP elevation. Therefore, a thorough examination for determining the cause of IOP elevation is recommended at the initial stage.

Transitions of the Understanding and Definition of Primary Glaucoma / 中华医学杂志(英文版)

Objective@#In previous decades, glaucoma has been primarily attributed to elevated intraocular pressure (IOP), but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucoma in developed countries. However, there still remain strong controversies in the definition of glaucoma in China. In this current review, we are going to discuss these controversies and elaborate on the historical transitions of the definition of glaucoma both in China and developed countries. Furthermore, we will briefly describe the "ocular-cranial pressure gradient" theory and discuss the relationship between glaucoma and degenerative diseases of the central nervous system (CNS) in order to show the complex pathogenesis of glaucoma and the importance for the modification to the definition of glaucoma.@*Data Sources@#We performed a comprehensive search in both PubMed and SinoMed using the following keywords: (a) "primary glaucoma" and "guideline," (b) "ocular-cranial pressure gradient," and (c) "glaucoma," "Alzheimer's disease," and "Parkinson's disease." The literature search included the related articles with no restrictions on publication date.@*Study Selection@#The primary references were Chinese and English articles including (a) original guidelines and expert consensuses of primary glaucoma, (b) reviews focusing on the differences between various versions of these guidelines and consensuses, and (c) papers about ocular-cranial pressure gradient theory and the relationship between glaucoma and CNS degenerative diseases.@*Results@#The definitions and classifications of both primary open-angle glaucoma and primary angle-closure glaucoma differ between Chinese glaucoma consensuses and international primary glaucoma guidelines. Chinese definitions and classifications put more emphasis on the IOP, while international guidelines put more emphasis on the presence of optic neuropathy. The ocular-cranial pressure gradient theory and the research on the relationship between glaucoma and CNS degenerative diseases have provided new directions for exploring the pathogenesis of glaucoma.@*Conclusions@#As regards the definition and classification of primary glaucoma, we find that there are still some discrepancies between Chinese expert consensuses and international guidelines. Glaucoma is a disease with complex etiologies, while its common characteristic is a specific optic neuropathy. The current definition and understanding of glaucoma is an ongoing and evolving process, reflecting our latest available evidence on its pathogenesis. Chinese ophthalmology community may need to update our guidelines, accommodating these latest developments.

Diagnostic value of mGCC in primary glaucoma and its correlation with pRNFL and visual fields / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the diagnostic value of macular ganglion cell complex(mGCC)in primary glaucoma and explore the correlation between mGCC and peripapillary retinal nerve fiber layer(pRNFL)and visual field, in order to provide scientific reference for the diagnosis and treatment of primary glaucoma. <p>METHODS: Eighty eyes in 67 primary glaucoma patients admitted to our hospital from January 2015 to December 2016 were included in the observation group. Another 80 eyes in 40 healthy subjects in our hospital were included in the control group during the same period. The mGCC and pRNFL thicknesses of two groups were measured with an optical coherence tomography(OCT). The thickness of mGCC and pRNFL and visual field were compared between the two groups. The diagnostic value of mGCC for primary glaucoma was analyzed. The correlation between mGCC and pRNFL and visual field mean defect was detected. <p>RESULTS: The superior, inferior and average mGCC thickness in the observation group was significantly lower than that in the control group(<i>P</i><0.05). The superior, inferior and average pRNFL thickness in the observation group were significantly lower than those in the control group, the difference was statistically significant(<i>P</i><0.05). The visual field mean defect in the observation group was significantly higher than that in the control group, the difference was statistically significant(<i>P</i><0.05). Pearson correlation analysis showed that there was a significant positive correlation between mGCC and pRNFL(<i>r</i>=0.58, <i>P</i><0.01)and there was a significant negative correlation between mGCC and the average visual field defect(<i>r</i>=-0.69,<i> P</i><0.01)in the observation group. ROC curve analysis showed that the intercept point value of mGCC in the diagnosis of primary glaucoma was 86.39μm. The sensitivity was 82.5% and the specificity was 76.25%. <p>CONCLUSION: The mGCC has a certain diagnostic value for primary glaucoma. There is positive correlation between mGCC and pRNFL and negative correlation between that and visual field mean defect.

Detective values of optical coherence tomography angiographyfor primary glaucoma / 眼科新进展

Objective To investigate the diagnostic significance of optical coherence tomography angiography (OCTA) in the detection of primary glaucoma.Methods Totally 70 patients (116 eyes) of primary glaucoma were selected as the experimental group and 20 normal subjects (36 eyes) as the control group.The changes in macular vessel density,macular retinal ganglion cell (RGC) thickness,macular thickness,and optic disc retinal pigment epithelium (RPE) opening distance were measured by OCTA,and the correlation between the parameters and the mean deviation (MD) of visual field.Results When compared with the control group,the upper macular thickness,inferior macular thickness,macular RGC thickness and macular vessel density were reduced in the experimental group (all P ＜ 0.05).There was no significant difference in optic disc RPE opening distance between the control group and the experimental group (F =2.646,P =0.051 3).Linear positive correlations were found between macular thickness,macular RGC thickness,macular vessel density and MD (all r ＞ 0.5,P ＜0.01).The area under the curve of the diagnostic ROC curve of the macular vessel density,macular RGC thickness and mactlar thickness for glaucoma were all greater than 0.7.Conelusion There are linear positive correlations between macular thickness,macular RGC thickness,macular vessel density and MD.The parameters have a high diagnostic ability for the primary glaucoma.OCTA is a valuable technique for detecting glaucoma.

Progress in the detection of macular ganglion cell complex thickness / 第二军医大学学报

Retinal ganglion cells are closely related to visual function. Retinal ganglion cell apoptosis and axonal injury can be found in many blinding eye diseases, such as primary glaucoma, optic neuritis, diabetic retinopathy, and atrophic age-related macular degeneration. Ganglion cells mainly exist in the retinal nerve fiber layer, the ganglion cell layer and the inner plexiform layer of the macular area. These three structures are collectively referred to as the retinal ganglion cell complex, and change of the thickness reflects the state of the retinal ganglion cell. It has been reported that ganglion cell complex thickness is thinner in the injured retinal ganglion cells. Therefore it is important to detected thickness of retinal ganglion cell complex in the diagnosis of ocular disease and the evaluation of its severity and prognosis. In this paper, we reviewed the recent progress in the detection of retinal ganglion cell complex thickness in various eye diseases to assist the early diagnosis, treatment and evaluating prognosis of associated ophthalmopathy.

Clinical study of phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of primary chronic angle closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To evaluate the efficacy of phacoemulsification and intraocular lens ( IOL ) implantation combined with goniosynechialysis in the treatment of primary chronic angle closure glaucoma.·METHODS: Eighty patients ( 96 eyes ) with primary chronic angle closure glaucoma were divided into observation group (40 cases, 46 eyes) and control group (40 cases, 50 eyes). The treatment group was treated with phacoemulsification, intraocular lens implantation and goniosynechialysis, while the control group was treated with phacoemulsification and intraocular lens implantation. The best corrected visual acuity, intraocular pressure, visual field mean deviation (MD), mean sensitivity ( MS) and the central anterior chamber depth of the two groups before and after the surgery were compared, and the occurrence of complications in patients with postoperative were record.·RESULTS:The best corrected visual acuity, visual field, intraocular pressure and central anterior chamber depth of the two groups before operation showed no significant differences (P>0. 05). The best corrected visual acuity, visual field, intraocular pressure and central anterior chamber depth between the groups at 6mo postoperatively showed statistically significant (P<0. 05). There was no serious complications in the two groups, and the difference between the two groups showed no statistically significant (x2=0. 351, P=2. 095).· CONCLUSION: The application of the phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of primary chronic angle closure glaucoma is more effective than the simple use of phacoemulsification and intraocular lens implantation.

Research progress of the spectral-domain optical coherence tomography for glaucoma diagnosis / 中华实验眼科杂志

Optical coherence tomography (OCT) has the advantage of non-contact,good repeatability and quick to obtain retinal image.With the rapid development of resolution and scanning speed,OCT has been more widely used in the field of ophthalmology.OCT has developed from time-domain OCT (TD-OCT) to spectral-domain OCT (SD-OCT).OCT can diagnose glaucoma without visual field damage and play an important role in monitoring and diagnosing the progression of primary open angle glaucoma.In recent years,SD-OCT has made an enoumous contribution to the detection and diagnosis of glaucoma,by detecting retinal nerve fiber layer (RNFL) thickness,structural parameters of optic disc as well as the macular ganglion cell complex (mGCC) thickness.This paper reviewed the relevant researches of the three parameters obtained from SD-OCT on the diagnosis of primary glaucoma.

Clinical value of PEDF ,A beta ,Hcy and β-EP in the diagnosis of primary glaucoma / 国际检验医学杂志

Objective To investigate the change of serum pigment epithelium derived factor (PEDF) ,β amyloid (Aβ) ,homocysteine (Hcy) and β endorphin (β-EP) levels in the patients with primary glaucoma and their clinical value .Methods 93 cases of primary glaucoma and 93 healthy people from July 2011 to June 2015 were selected as the primary glaucoma group and control group respectively .The ultrasound biomicroscopic examination results served as the golden standard .The changes of PEDF ,Aβ,Hcy and β-EP levels were observed in the two groups .Their sensitivity ,specificity and accuracy were compared .Results The PEDF level in the primary glaucoma group was significantly lower than that in the control group ,while serum Aβ,Hcy and β-EP levels were significantly higher than those in the control group ,the differences were statistically significant (P＜0 .05) .In the Richardson stage of primary glaucoma severity ,the higher the grade ,the higher the serum Aβ,Hcy and β-EP levels ,while the lower the PEDF level ,the differences were statistically significant (P＜0 .05) .The sensitivity ,specificity and accuracy of serum PEDF ,Aβ,Hcy and β-EP combined detection were 97 .26% ,90 .00% and 95 .70% respectively ,which were significantly higher than that of single index detection or other indexes combined detection(P＜0 .05) .Conclusion The levels of serum PEDF ,Aβ,Hcy and β-EP are higher in the patients with primary glaucoma and their combined detection has a great value for evaluating the severity of primary glaucoma .

Application in diagnosis of primary glaucoma by macular ganglion cell complex thickness measurement with spectral-domain OCT / 国际眼科杂志(Guoji Yanke Zazhi)

Glaucoma is a group of irreversible blind eye diseases with specific optic nerve damage and visual field defect. Early diagnosis and treatment of glaucoma is vital for prognosis, but difficult in clinical practice. Macular ganglion cell complex thickness(mGCC) consists of the inner three layers of retina:retinal nerve fiber, ganglion cell and inner plexiform layers, which is glaucoma target tissue so to be measured the thickness of the mGCC as better indicator for early diagnosis in glaucoma. Optical coherence tomography ( OCT ) is a non-contact, good repeatability technique to obtain fast high- resolution images from the anterior and posterior segments of the eye, and it has been widely used in ophthalmology. Spectral- domain ( SD ) OCT allows a higher image resolution and can measure the thickness of mGCC thickness, providing new parameters for the early diagnosis of glaucoma.

Impact of initial topical medical therapy on short‑term quality of life in newly diagnosed patients with primary glaucoma.

Purpose: To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33). Patients and Methods: The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months. Results: Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40–77 years) and controls (mean age: 54.9 ± 6.7 years, 42–73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01). Conclusions: Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy.

Randomized-controlled trial of anti-scarring effectiveness on filtrating surgery combined with amniotic membrane / 中华实验眼科杂志

Background The scar formation of filtering bleb is a cause of filtering operation failure.The topical application of mitomycin C (MMC) can inhibit the growth of collagenous fiber and improve function of bleb.However,some adverse effects of MMC are being closely concerned.Many studies have conformed the efficacy of amniotic membrane in filtering operation,but the comparison study between MMC and amniotic membrane is still lack.Objective Purpose of this study was to evaluate the anti-scarring effectiveness of amniotic membrane after its use in the filtrating surgery.Methods A randomized,controlled trial was designed.This study was approved by Ethic Committee of Peking University Third Hospital Eye Center.Written informed consent was obtained from each patient initial of this study.Fifty-two eyes of 47 patients with primary glaucoma were included in Peking University Third Hospital Eye Center from October 2009 to October 2011.The eyes were divided into two groups according to single blindness design and randomized digital table.Trabeculectomy combined with amniotic implantation was performed in the patients of the amniotic group,and trabeculectomy combined with 0.02％ MMC in the patients of the MMC group.The patients were followed-up for 3 months.Intraocular pressure (IOP),the anterior chamber depth,filtering bleb shape,incidence of complication and operative efficacy were measured and evaluated.Results No significant difference was found in the demography between two groups (P＞0.05).Seventeen patients in the MMC group and twenty-two patients in the amniotic group finished the trial.The IOP in the amniotic membrane group was (16.60-±5.04) mmHg on the third month after operation and that before operation was(23.52±-6.52) mmHg.In the MMC group,the IOP was(24.09± 12.79) mmHg on the third months after operation,and that before operation was (17.04±3.69) mmHg.Significant difference was found in the IOP between preoperation and postoperation in both groups(P＜0.05).IOP differential value on the third month was 6.98 mmHg in the amniotic membrane group and 6.94 mmHg in the MMC group.No significant differences were seen in the IOP between the amniotic membrane group and the MMC group in 1 week,2 weeks,1 month and 3 months(t=0.972,P=0.336;t=-0.512,P=0.611;t =-0.372,P =0.712 ; t =0.427,P =0.672).There were no significant differences in the number of eyes in the height grade,vascularization and perimeter classification of the filtering blebs 1 week,2 weeks and 1 month after surgery between these two groups (x2 =0.991,P =0.320 ; x2 =0.474,P =0.491 ; x2 =2.008,P =0.156).The total effective rate of surgery was 90.49％ in the amniotic membrane group and 100％ in MMC group,with a significant difference between them(x2 =26.180,P=0.000).There were not significantly different in the incidences of bleb leakage in 1 week,2 weeks and 1 month after operation between the MMC group and the amniotic group(x2 =3.556,P =0.059;x2=1.129,P=0.800; x2=0.434,P =0.510).Conclusions Combination of trabeculectomy with amniotic implantation has a similar lowing-IOP effect to trabeculectomy combined with MMC.The incidence of bleb leakage in the trabeculectomy combined with amniotic implantation dose not increase when compare with trabeculectomy combined MMC.

Costos directos del glaucoma primario de ángulo abierto / Direct costs of open angle primary glaucoma

Introducción: la magnitud del costo asociado al glaucoma primario de ángulo abierto deriva de la atención sanitaria y de la disminución de la calidad de vida del paciente. Objetivos: estimar los costos del glaucoma primario de ángulo abierto en los pacientes atendidos durante el 2010 en el servicio de glaucoma del hospital Dr Salvador Allende. Métodos: se realizó un estudio retrospectivo, en el campo de la Evaluación Económica en Salud es un estudio del tipo de descripción de costos, que aplicó el enfoque metodológico del costo de la enfermedad. El universo de estudio estuvo constituido por el total de casos con diagnóstico de glaucoma primario de ángulo abierto que acudieron a la consulta seleccionada de glaucoma del citado hospital, durante el primer trimestre del 2011 y que habían sido atendidos durante el 2010. Los costos fueron expresados en pesos cubanos del 2010. El estudio se realizó a partir de las perspectivas de la institución y la del paciente. Resultados: el estudio incluyó 110 pacientes con edad promedio de 60,3 años de edad. El costo promedio de la atención a un paciente en la institución fue de 230,99 pesos cubanos. El costo promedio para los pacientes fue de 290,10 pesos cubanos. Conclusiones: el servicio de glaucoma cuenta con los recursos científico técnicos imprescindibles para la atención de los pacientes. Los costos de la enfermedad para el paciente son cubiertos con los ingresos monetarios que estos perciben

Introduction: the magnitude of the cost of open angle primary glaucoma stems from the health care and the reduction of the patient's quality of life. Objectives: to estimate the open angle primary glaucoma costs in those patients seen at the glaucoma service of Salvador Allende hospital during 2010. Methods: a retrospective cost description-type study, which applied the methodological approach to the disease costs, was carried out in the field of health economic assessment. The universe of study was the total number of cases diagnosed as open angle primary glaucoma and seen at the glaucoma service during the first quarter of 2011 and those which had been treated during 2010. The costs were given in Cuban pesos, according to the 2010 rate. The study was conducted on the basis of the perspectives of the institution and those of the patients. Results: the study comprised 110 patients aged 60.3 years. The average cost of assistance to a patient at the hospital was 230.99 Cuban pesos. The average cost for the patients was 290.10 Cuban pesos in the analyzed period. Conclusions: the glaucoma service has the indispensable scientific and technical resources for the care of patients. The costs of the disease for the patients are afforded by their own incomes

Coping strategies and influence factors among primary glaucoma patients / 中国实用护理杂志

Objective To explore coping strategies and influence factors in primary glaucoma patients through describing characteristics of their coping strategies.Methods From November 2007 to June 2008,data were collected from 120 primary glaucoma patients in three hospitals in Guangzhou and Shenzhen.The final sample consisted of 100 patients and the data underwent analysis.Results Among different coping styles of primary glaucoma patients,facing was lower than norm,avoiding and yielding were higher than norm.The factors related to coping style were age,different cohabitant,different economic condition,different occupation,different educational level and health payment mode.Conclusions Primary glaucoma patients usually took avoiding or yielding coping styles.Nurses should help patients with low income and education background to face the disease positively.Besides,fully consideration should be given to patients with different age,at the same time,marriage and family support should also exert active function.

Research in relationship of personality traits and coping strategies among primary glaucoma patients / 中国实用护理杂志

Objective The purposes of this study were to explore the relationship between personal-ity traits and coping strategies among primary glaucoma patients. Methods 100 patients with primary glaucoma participated the investigation adopting Eysenck Personality Questionnaire (EPQ) and the Medical Coping Methods Questionnaire (MCMQ). Data underwent analysis using descriptive and Spearman rank correlation methods. Results L(lie scale) was (57.83±4.13). The primary glaucoma patients usually took different coping style from norm, facing was (16.91±2.21), avoiding was (15.69±2.01), yielding was (11.54±2.03), all was significantly different than those of norm. L was evidendy negatively correlated with facing, positively correlated with avoiding. Conclusions The personality traits of primary glaucoma pa-tients are different from norm people. They usually take avoiding and yielding coping style, while facing coping style is rarely adopted. Patients with exocentric personality and easy to communicate are apt to adopt positive coping style, while in patients who are identical in emotion and lie, they may take avoiding and yielding coping styles.

A clinical experimental study on the relationship between primary glaucoma and retinal blood perfusion due to blood viscosity / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the relationship between levels of blood viscosity and ocular hemodynamic changes in patients of primary glaucoma (PG).METHODS: The blood rheology indices (including whole blood, plasma, packed cell, relative blood visco-sities and yield stress) were determined in primary open angle glaucoma (POAG) patients, primary acute angle closure glaucoma (PAACG) patients, primary chronic angle closure glaucoma (PCACG) patients and normal control group (patients with senile cataract), 20 cases each group. The peak systolic velocity (PSV), end diastolic velocity (EDV), resistant index (RI), shape of spectra and frequency of monitor of ophthalmic artery (OA) and central artery of retina (CRA) were detected with color Doppler imaging (CDI) simultaneously. Comparing to the differences of each group with t test and giving a linear relational analysis to targets between the blood viscosity and hemodynamic of primary glaucoma patients.RESULTS: The blood rheology targets in PG groups were significantly higher than those in control group except fibrinogen. Comparing to control group, PSV and EDV in PG groups were significantly decreased but RI was remarkably increased. All targets of blood viscosity in PG patients were significantly negatively correlated with the PSV, EDV of both OA and CRA, but were significantly positively correlated with RI of OA and CRA. There were no significant correlations between the blood viscosity and ocular hemodynamics in the normal control.CONCLUSION: There are ocular blood circulation obstacles in and high level of blood viscosity PG patients, CDI has an important reference value in early diagnosis and prognosis of glaucoma.

Características clínicas de los pacientes con glaucoma pediátrico atendidos en la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lülle / Clinical characteristics of paediatric glaucoma patients treated in Fundación Oftalmológica de Santander Clínica Carlos Ardila Lülle

Objetivo: Caracterizar los pacientes atendidos por glaucoma pediátrico, identificar el tratamiento más utilizado para cada subgrupo y conocer los resultados en referencia al control de la presión intraocular. Método: Estudio retrospectivo mediante revisión de historias clínicas de pacientes con glaucoma pediátrico menores de 15 años, pertenecientes al servicio de oftalmopediatría de la Fundación Oftalmológica de Santander Clínica Carlos Ardilla Lülle, atendidos entre enero/2001 y diciembre/2006. Resultados: Del total de casos recolectados, 46 pacientes tenían glaucoma congénito primario, 15 pacientes con glaucoma del desarrollo y 21 pacientes con glaucoma secundario. La técnica quirúrgica más utilizada fue la trabeculotomía combinada con trabeculectomía (TCO+TCE), seguido por la trabeculectomia aumentada con mitomicina (TCE+MMC) y el tratamiento médico tópico con hipotensores oculares. Conclusiones: El glaucoma congénito primario es la causa más frecuente de glaucoma en niños y la técnica combinada de TCE+TCO es el procedimiento de elección con una tasa de éxito del 69.6%.

Background: Glaucoma infrequently affects infants and children, as compared with adults. The prognosis of any glaucoma is better if it is diagnosed early and brought under control. In our experience, primary congenital glaucoma is the most common paediatric glaucoma, and for this condition, combined trabeculotomy+trabeculectomy is the procedure of choice. Objective: To characterize patients seen with paediatric glaucoma, to identify the most often used treatment for each subgroup and the results in reference to the intraocular pressure control. Method: Retrospective clinical record review of paediatric patients with glaucoma under 15 years old, treated in Oftalmopediatrics Service of the Ophthalmologic Foundation of Santander Carlos Ardila Lülle Clinic attended from January/2001 to December/2006. Results: 46 patients had primary congenital glaucoma, 15 had developmental glaucoma, and 21 had secondary glaucoma. The surgical technique most frequently used was trabeculotomy combined with the trabeculectomy (TCO + TCE), followed by trabeculectomy augmented with mitomycin (MMC + TEC) and medical treatment topic with ocular hypotensive. Conclusions: The primary congenital glaucoma is the most frequent cause of glaucoma in children and the combined technique TEC + TCI is the procedure of choice with success rate of 69.9%.

Clinical Factors that Influence Intraocular Pressure Change after Cataract Surgery in Primary Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To evaluated the effect of cataract surgery on intraocular pressure (IOP) in primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG), and to find predictors for a favorable postoperative IOP after cataract surgery in patients with coexisting cataract and glaucoma. METHODS: Various clinical factors were evaluated in 68 patients (76 eyes) with well controlled primary glaucoma who had undergone cataract surgery. The differences in parameters between groups divided by postoperative IOP course were analyzed. RESULTS: For this study, successful IOP control was defined as an IOP between 6 mmHg and 21 mmHg without anti-glaucoma medication at last visit after cataract surgery. Eyes with the highest preoperative IOPs less than 28 mmHg in POAG and 42 mmHg in PACG had a significantly higher probability of success. In PACG, the probability of success was significantly higher, if fewer than three anti-glaucoma medications were given before surgery and if the areas of PAS before surgery were less than 4 hours. CONCLUSIONS: Primary small incision cataract surgery using phacoemulsification and foldable intraocular lens implantation could be considered the procedure of choice for a selective group of patients with coexisting glaucoma and visually significant cataract, with respect to IOP, the number of anti-glaucoma medications, and the area of peripheral anterior synechiae.