Costs of medical and surgical treatment of glaucoma.

PURPOSE: To compare county costs of medical and surgical glaucoma treatment. METHODS: Medical records of 470 patients who underwent trabeculectomies in 1992 were scrutinized for a period of 3 years before and 3 years after surgery (including the year of surgery). Treatment costs were based on DRG prices, and drug consumption costs on the "defined daily dose" (DDD). RESULTS: The costs rose steadily during the 3 years before surgery on account of more frequent visits and examinations and increased drug consumption. Mean total cost in the preoperative period was 13,355 SEK and that in the corresponding postoperative period, including surgery, was 23,684 SEK. The number of visits post-surgery was only slightly reduced, but there was a marked decrease in medication. However, the cost of the drugs was not correspondingly lower. Thirty percent of the patients later underwent cataract extraction. CONCLUSION: From a strictly economic point of view glaucoma surgery is not profitable within a 3-year postoperative period.

Consumption of glaucoma medication.

During recent decades consumption of antiglaucoma drugs has shown a steady increase in the Nordic countries. The cost increase can partly be explained by the use of newer, more expensive drugs. The increase in daily doses, however, is relatively much larger than the corresponding ageing of the population. There are large national and regional differences. Measured in daily defined doses (DDD) the consumption of glaucoma medication is almost three times as high in Sweden as in Denmark. Within all the Nordic countries there exists up to more than two-fold regional differences between high- and low-consuming counties. The new classes of IOP-lowering drugs have been very quickly adopted. Statistical data indicate that adding new drugs is more common than switching to a new therapy.

Blindness in glaucoma patients.

In order to determine the risk for bilateral blindness from glaucoma and to which extent other diseases are responsible for the disability, the registers of low vision clinics were surveyed. All registered patients still alive in 1991 with the diagnosis of glaucoma were included. Eighteen hundred and ninety-five patients fulfilled these criteria. Blindness was defined as bilateral visual acuity < or = 0.1. The majority of the patients (68%) had a visual acuity better than 0.1. The remaining 590 patients had a visual acuity < or = 0.1. In this latter group glaucoma was the reason for the low visual acuity in 20%, glaucoma in combination with other eye diseases in 35% and other eye diseases in 44%. Macular degeneration and cataracts were the main causes of the low vision in the latter group. The prevalence of glaucoma blindness in the Stockholm region was found to be 0.007% for glaucoma and 0.020% for glaucoma in combination with other eye diseases.

Cataract development in adult bone marrow transplant recipients.

In a prospective study, adult patients treated with bone marrow transplantation were examined with respect to cataract development. There were 99 patients with a survival of at least one year. Ten of them had aplastic anemia and the rest had various hematological malignancies. Mean follow-up time was 3.9 years (range 1-10). All in the hematological malignancies group but none in the aplastic anemia group, were conditioned with irradiation. Cytostatic drugs were administered in all cases. Depending on the type of disease and its reaction to bone marrow transplantation, steroid treatment was sometimes indicated. Cataract did not occur in any of the 10 patients treated for aplastic anemia, whereas all patients with hematological malignancies had developed cataract after 4 years' observation. Most patients in the hematological malignancies group already showed lens opacifications after 2 years. Cataract surgery on the first eye was performed in 39 cases, a median of 3.7 years after bone marrow transplantation. Cataract development was clearly correlated to radiation. No relationship was found to other conditioning treatments, although a synergistic effect is possible.

Intraocular pressure after extracapsular cataract extraction with implantation of posterior chamber lenses.

To determine factors which influence postoperative intraocular pressure (IOP) we retrospectively reviewed changes in pressure during the first postoperative week in 633 consecutive eyes undergoing extracapsular cataract extraction (ECCE) with implantation of a posterior chamber lens. The material was restricted to four surgeons and two types of lenses. IOP was measured preoperatively, one day and one week after surgery. Glaucomatous eyes (n = 113) as well as exfoliative non-glaucomatous eyes (n = 79) had a higher mean IOP (27.8 and 26.1 mmHg) the first postoperative day compared to 'simple' cataract eyes (20.1 mmHg). After one week mean IOP in glaucomatous eyes still remained elevated while exfoliative non-glaucomatous eyes had regained preoperative values. Mean IOP on the first postoperative day (18.8, 24.5, 23.1 and 13.2 mmHg respectively) was also dependent on surgeon. To some extent the IOP could be correlated to tightness of suturing as estimated by keratometry. Only one surgeon had significant difference between irrigated and non-irrigated visco-elastic substance. Postoperative pressure was not only dependent on the status of the patient's eye, but factors for the individual surgeons seemed to be as important.

Cataract development and outcome of surgery in bone marrow transplanted children.

Cataract development in bone marrow transplanted (BMT) patients was studied prospectively. There were 61 children, transplanted before the age of 18 years, who survived more than 1 year after transplantation. Patients transplanted for leukaemia (n = 43) were conditioned before BMT with cyclophosphamide (Cy) and total body irradiation (TBI). Patients with severe aplastic anaemia (SAA) (n = 9) only received Cy. None of the patients with SAA developed cataracts. All children with leukaemia, who were followed for at least 3 years (n = 37), developed lens posterior subcapsular cataracts (PSC). Cataract extraction was performed in 28 eyes, on average 5.1 years (range 3-9 years) after BMT. Postoperative corrected visual acuity was similar to that before BMT. The majority of cases needed laser capsulotomy within 2 years after cataract extraction. TBI seems to be the main cause for the high incidence of cataract after BMT. A relationship to steroid administration could not be proved, but a contributory effect is not excluded.

Pressure control in glaucoma patients after cataract surgery with intraocular lens.

In a retrospective study 97 patients with glaucoma and 16 with ocular hypertension were examined with regard to intraocular pressure (IOP) after extracapsular cataract extraction with implantation of a posterior chamber lens. During the follow-up 39 cases dropped out but 63 glaucoma patients and 11 patients with ocular hypertension were followed for three years. Compared to preoperative IOP 59% of the patients treated previously with Argon laser trabeculoplasty (ALT) had an IOP rise of > 10 mm Hg the day after surgery. The corresponding proportion among medically treated patients was 34% (P = 0.01). A pressure rise of > 10 mm Hg was less frequent among patients treated with one drug than among those treated with two or three (P = 0.05). During follow-up eight patients had a pressure rise which could not be controlled medically and they had to undergo additional ALT or surgery. All eight had been treated with ALT or with glaucoma filtering surgery prior to the cataract operation. After three years observation of 63 of the glaucoma patients, 63% were having less medical therapy than preoperatively, 30% an equal amount and 7% more; 49% (31 of 63) were still without any therapy. In the group of patients who preoperatively were only treated medically, no definite increase in therapy was needed in the long term.

Factors influencing the formation of posterior capsular opacities after extracapsular cataract extraction with posterior chamber lens implant.

This study was designed to determine whether different factors could influence the formation of posterior capsular opacities. The study group comprised 271 patients who had undergone an extracapsular cataract extraction with implantation of a posterior chamber lens either with or without laser ridge. Between 12 and 25 months after surgery, a statistically significant difference was found with a lower rate of secondary cataract in the laser ridge group, but with respect to advanced secondary cataract, i.e. eyes which needed YAG capsulotomy, no statistically significant difference was found (P-value 0.99). No association was found between age or sex of patients, different surgeons or complications during or after surgery and the risk of getting a secondary cataract.

[Retinal changes--degeneration or side effect caused by etretinate (Tigason) therapy?]. / Retinale Veränderungen--Degeneration oder Nebenwirkung durch Etretinat (Tigason)-Therapie?

Case report of retinal changes in a patient treated with etretinate (Tigason). The possibility of drug-induced retinopathy is discussed.

Ophthalmopathy and hyperthyroidism. A comparison between patients receiving different antithyroid treatments.

The ocular manifestations in 125 thyrotoxic patients observed for 6-20 years are presented. The incidence and development of ophthalmopathy in three different treatment group medical- (eta = 72), radionuclear (eta = 36) and surgical (eta = 17) are showed. The degree of ophthalmopathy is similar in all groups, and no statistically significant difference is found in the development of ophthalmopathy.

Work with video display terminals among office employees. III. Ophthalmologic factors.

The present ophthalmologic study is the third part of a major epidemiologic health investigation on work with a video display terminal (VDT). An initial study showed that VDT operators replying to a questionnaire reported more eye discomfort than a reference group not employed in VDT work and that women reported more eye discomfort, musculoskeletal discomfort, headache, and skin disorders than men, irrespective of whether or not they were employed in VDT work. In the present study the ophthalmologic history of eye diseases and eye discomfort yielded a much lower percentage response for symptoms and discomfort than the questionnaire, and, just as with visual acuity and refraction, there was no difference between the exposed and reference groups or between the men and women. The exposed subjects were found to be overcorrected in terms of presbyopia addition in relation to work distance. As regards ocular examination findings, low frequency rates were noted for pathological lens opacities. Opacities of this kind were slightly more frequent among the VDT operators than among the referents, but the difference was not statistically significant. There were no other differences in the ocular findings of the exposed and reference groups.

Timolol in aqueous humour after topical administration. A pilot study.

The concentration of timolol in aqueous humour after one single drop of timolol ophthalmic solution was studied in 19 patients. Relatively high concentrations were found (mean: 626 ng/ml), but the individual differences were great (range: 0 ng/ml - 2080 ng/ml). Possible explanations are discussed. No detectable levels of timolol were found in plasma (detection level greater than or equal to 1 ng/ml).

Additive intraocular pressure reducing effect of topical timolol during systemic beta-blockade.

The effect on intraocular pressure (IOP) of topical timolol was studied in 30 patients with arterial hypertension treated with oral alprenolol, metoprolol or timolol. No patient had any known eye disorder. Topical administration of timolol induced a significant reduction of IOP regardless if the patients had systemic beta-blockade or not. Treatment with topical timolol alone was equally effective in reducing IOP as combined topical and oral therapy. Patient compliance was checked with plasma concentrations of the different beta-blockers.

Timolol-maintenance treatment.

Thirty-eight patients with ocular hypertension or glaucoma were treated with topical timolol for 12-30 months (mean 20). A long lasting hypotensive effect of timolol eyedrops was found. However a need to increase therapy during the follow-up period was noted especially in the glaucoma group. Eyes with pseudoexfoliations often required concomitant therapy from the beginning. Ocular side effects were relatively few but four cases of punctate keratitis and another two with decreased corneal sensitivity were observed.