ABSTRACT
PURPOSE: The aim of this study was to evaluate a scoring system for chronic open-angle glaucoma. We devised an empirical scoring system grading severity of the disease and correlated this with treatment. MATERIAL: and methods: Ninety patients were evaluated on 11 parameters: 1) Family history of glaucoma: blindness (2), yes (1) no (1); 2) Age: infantile (4), juvenile (4); 3) Race: Caucasian (0), Asian (1), Afro-Caribbean (2); 4) Myopia: 0-6 diopters (1), 6-12 diopters (2),>12 diopters (3); 5) Pigment dispersion or pseudoexfoliation (1); 6) Intraocular pressure without treatment:>30 mmHg (4); 25-30 mmHg (3), 20-25 mmHg (2); 7) Corneal central thickness:<500 micro m (3),>500 micro m (0); 8) Optic disc appearance: suspect (1), pathological (4); 9) Visual field defect: early (1), moderate (3), advanced (5); 10) Vascular risk factors: yes (1), no (0); 11) Loss of eyesight in one eye due to glaucoma (4). Scoring values were 2-34. We correlated this score with patient treatment: medical or surgical, number of glaucoma medications. RESULTS: Patients were divided into three groups: group 1 (36 patients), score 0-8; group 2 (24 patients), score 9-13; group 3 (30 patients), score above 13. Distribution between patients treated with medicine (mean number of medications) and patients with filtering surgery was: group 1, medical treatment with 1.63+/-0.73 medications, surgery 4/36; group 2, medical treatment with 2.00+/-0.7 medications, surgery 17/24 and group 3, medical treatment with 2.12+/-0.67 medications, surgery 27/30. In group 1, 88% of the patients did not have filtering surgery, but 90% of the patients in group 3 had filtering surgery. CONCLUSION: This scoring system seems to be an easy and practical tool to evaluate chronic open-angle glaucoma, which could also be used to evaluate target pressure. Other studies are necessary to validate this scoring system.
Subject(s)
Glaucoma, Open-Angle/diagnosis , Adolescent , Adult , Child , Chronic Disease , Humans , Severity of Illness IndexABSTRACT
The subject is to compare the middle term efficiency of surgical peripheral iridotomy and Argon laser iridotomy for primary closed angle glaucoma. We have considered reopened angles on 360 degrees after a crisis of closed angle; eyes with a positive "neosynephrine - pilocarpine" test; the second eye of a primary closed angle glaucoma and primary mixed glaucoma. Sixty affected eyes have been divided in two groups in a randomized study. Group A: Thirty eyes requiring a bilateral surgical peripheral iridectomy, Group B: Thirty eyes requiring a bilateral Argon laser iridotomy. The patients are regularly followed at intervals of: one week, three months, six months, one year and two years. Four parameters have been researched: 1. Intraocular pressure between 9 h-12 h a.m. Intraocular pressures lower or equal to 22 mmHg were considered to be successes. 2. Far visual acuity with correct lenses. 3. Opacity of the crystalline lenses: normal or sclerosed (0, +/-, +) cataract (++, ). 4. Post-operative complications. Some cases have required several periods of Argon laser photocoagulation (colorless iris, older patients) but we prefer a proper result immediately in order not to take any risks with pupillary blocking-up. The statistical analysis gives the following results: Same tonometric results according to the different technics even if the treatment has been prophylactic (positive provocation test; second eye) or curative (primary closed-angle glaucoma with solvable crisis; mixed glaucoma). No significant difference of visual acuity between the two groups after two years. Similarly, we have not found a significant difference between both techniques in each considered age group two years after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Glaucoma/surgery , Iris/surgery , Laser Therapy , Light Coagulation , Adult , Aged , Aged, 80 and over , Female , Humans , Intraocular Pressure , Male , Middle Aged , Postoperative Period , Prospective Studies , Random Allocation , Visual AcuityABSTRACT
Forty patients with chronic open-angle glaucoma or ocular hypertension participated in this randomized double-masked clinical trial. The patients instilled either 0.5% Levobunolol or 0.5% Timolol into each eye twice daily for three months. Levobunolol produced an overall decrease in mean intraocular pressure of approximately 7 mmHg, while Timolol produced an overall decrease of approximately 5 mmHg but no significant difference has been proved. Intraocular pressure was inadequately controlled in five patients in each treatment group. Both drugs caused heart rate decreases that were judged to be of limited clinical significance. Levobunolol was found to be as safe and effective as Timolol for the treatment of patients with open-angle glaucoma as for those with chronic ocular hypertension.
