ABSTRACT
OBJETIVO: Realización de una guía de práctica clínica actualizada sobre el tratamiento médico, láser y quirúrgico del glaucoma por cierre angular primario (GCAP) en el adulto. MÉTODOS: Tras la formulación de preguntas clave utilizando el esquema PICO (Paciente/Problema, Intervención, Comparación, Outcome/Resultado), se realiza una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR y «Risk of Bias» para la evaluación de la calidad de la información. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo el sistema Scottish Intercollegiate Guidelines Network (SIGN). RESULTADOS: Siguiendo la metodología expuesta, se presentan recomendaciones de tratamiento médico, láser y quirúrgico en el GCAP del adulto y los niveles de evidencia. CONCLUSIONES: Aunque el nivel de evidencia científica para muchas de las preguntas planteadas no es muy alto, se presenta una revisión actualizada de las recomendaciones terapéuticas en el GCAP del adulto. Entre las limitaciones para la aplicación de estas recomendaciones se encuentra que la mayoría de los estudios han sido realizados en población de origen asiático, y que la eficacia se mide casi exclusivamente en términos de reducción de tensión ocular y no en parámetros de función visual, calidad de vida o coste-efectividad
OBJECTIVE: To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. METHODS: Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation was established following the Scottish Intercollegiate Guidelines Network (SIGN) system. RESULTS: Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented. CONCLUSIONS: Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. Among the limitations for the implementation of these recommendations is that most studies have been conducted in Asian populations, and that the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, and does not include visual function, quality of life or cost-effectiveness parameters
Subject(s)
Female , Humans , Male , Glaucoma/chemically induced , Glaucoma/metabolism , /standards , Lasers , Lasers , Pharmaceutical Preparations/administration & dosage , Pharmaceutical Preparations , Cataract/diagnosis , Cataract/metabolism , Glaucoma/complications , Glaucoma/diagnosis , Lasers/classification , Lasers/standards , Pharmaceutical Preparations/analysis , Pharmaceutical Preparations/classification , Cataract/complicationsABSTRACT
OBJECTIVE: To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. METHODS: Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation was established following the Scottish Intercollegiate Guidelines Network (SIGN) system. RESULTS: Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented. CONCLUSIONS: Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. Among the limitations for the implementation of these recommendations is that most studies have been conducted in Asian populations, and that the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, and does not include visual function, quality of life or cost-effectiveness parameters.
Subject(s)
Glaucoma, Angle-Closure/therapy , Practice Guidelines as Topic , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Antihypertensive Agents/therapeutic use , Chronic Disease , Combined Modality Therapy , Drug Therapy, Combination , Evidence-Based Medicine , Glaucoma, Angle-Closure/drug therapy , Glaucoma, Angle-Closure/surgery , Humans , Intraocular Pressure/drug effects , Laser Therapy , Light Coagulation , Meta-Analysis as Topic , Middle Aged , Prostaglandins F, Synthetic/therapeutic use , Randomized Controlled Trials as Topic , Tonometry, Ocular , Young AdultABSTRACT
CASE REPORT: A 70-year-old male patient diagnosed with bilateral adult-onset vitelliform dystrophy presented with a sudden decrease of vision in his left eye associated with the appearance of an occult type of neovascular membrane. It was treated with intravitreal ranibizumab due to juxtafoveal location of the membrane. Two injections were needed to induce total regression of the lesion. DISCUSSION: Intravitreal ranibizumab may be effective to induce morphological and functional improvement in cases of choroidal neovascularization secondary to adult-onset vitelliform foveomacular dystrophy. Further case series are required to confirm this observation.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Choroidal Neovascularization/drug therapy , Vitelliform Macular Dystrophy/complications , Aged , Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal, Humanized/administration & dosage , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/etiology , Humans , Intravitreal Injections , Male , Ranibizumab , Tomography, Optical CoherenceABSTRACT
Caso clínico: Varón de 70 años diagnosticado de distrofia foveomacular viteliforme del adulto(DFVA) que en el curso de su enfermedad presenta disminución brusca de visión en el ojo izquierdo coincidiendo con la aparición de una membrana neovascular oculta. Dada la localización yuxtafove al de la membrana, se decidió tratar con ranibizumab intravítreo, siendo necesarias 2 inyecciones para lograr el cierre completo de la lesión neovascular. Discusión: El uso de ranibizumab intravítreo puede ser una opción de tratamiento eficaz en la neovascularización coroidea secundaria a DFVA, y se precisan series de casos más amplias para poder confirmar esta observación(AU)
Case report: A 70-year-old male patient diagnosed with bilateral adult-onset vitelliform dystrophy presented with a sudden decrease of vision in his left eye associated with the appearance of an occult type of neovascular membrane. It was treated with intravitreal ranibizumab due to juxtafoveal location of the membrane. Two injections were needed to induce total regression of the lesion. Discussion: Intravitreal ranibizumab may be effective to induce morphological and functional improvement in cases of choroidal neovascularization secondary to adult-onset vitelliform foveomacular dystrophy. Further case series are required to confirm this observation(AU)
