非青光眼人群中血压和视盘结构关系的Thessa-loniki眼科研究

Purpose:To study the association of blood pressure(BP)status on the optic disk structure as measured with the Heidelberg Retina Tomograph(HRT)in people without glaucoma.Design:Cross-sectional population-based setting study.Methods:Consecutive participants in the Thessaloniki Eye Study were included in this study.HRT images of the optic disk and BP measurements were taken.Hypertension was defined as a systolic BP(SBP)≥ 140 mmHg,diastolic BP(DBP)≥ 90 mmHg,or both.Subjects were classified in three groups by SBP and DBP.The Kruskal-Wallis test was used to compare the three groups with respect to the HRT parameters.Regression models adjusted for age,gender,height,disk size,intraocular pressure,cardiovascular disease,diabetes,and duration of antihypertensive treatment were used for each HRT parameter to compare values among the different groups.The P value was considered significant at<.05.Results:A total of 232 subjects were included in the analysis.Rim area was signifi cantly different among groups when DBP was considered as the criterion to classify subjects(P=.005).In regression models,cup area,and cup-to-disk(c/d)ratio were increased in subjects with normal DBP that was the result of treatment,as compared with both the high DBP and untreated normal DBP groups.Conclusions:In patients without glaucoma,the DBP< 90 mm Hg that results from antihypertensive treatment is associated with increased cupping and decreased rim area of the optic disk.This information should be considered in research aiming to define the role of the BP status as an independent factor initiating optic disk changes and/or as a contributing factor to glaucoma damage.

青光眼医疗保险受益人术前的视野检查

Objective: The standard of care for progressive glaucoma that requires medical or surgical intervention includes visual field (VF) testing at least annually. This study aims to assess how commonly ophthalmologists performVF testing before planned glaucoma surgery in the Medicare population,and whether variations in conformance occur across demographic and clinical subgroups. Design: Retrospective, observational, populationbased analysis. Participants: Thirteen thousand seven hundred fifty- three Medicare beneficiaries. Methods: Data were obtained from a5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States from 1995 to 1999. The proportion of patients with evidence of at least 1 VF examination in the year before glaucoma surgery was determined. Main Outcome Measure: Rate of VF testing in the year before glaucoma surgery. Results: Overall, 70% of patients had at least 1 VF test in the year preceding glaucoma surgery. This rate was significantly lower (P< 0.001) in patients < 85 years (56% ), blacks (64% ), patients with race other than white or black (66% ), patients with diabetic retinopathy (60% ), and patients with bilateral blindness (47% ). Conclusions: The use of VF testing before surgery in glaucoma Medicare beneficiaries is suboptimal relative to the recommended standard of care. Underutilization is of particular concern in blacks, who are at increased risk of glaucomatous damage. Quality- of care initiatives are needed to facilitate appropriate preoperative evaluations of glaucoma Medicare beneficiaries for glaucoma surgery.

先天性青光眼术后上皮内生

To report epithelial downgrowth following goniotomy. Observational case report . Surgical management of a child with congenital glaucoma and epithelial downgro wth. One year after nasal goniotomy and multiple Ahmed valve revisions an epithe lial inclusion cyst was noted adjacent to the clear corneal goniotomy incision. Ab externo drainage and limbal cryotherapy were required twice for recurrent gro wth of the cyst. Six months after the second treatment the eye remains cyst-fre e. Epithelial downgrowth is a rare complication of surgery for glaucoma, but bec ause of its potential to threaten sight it should always be considered as a poss ible complication.

高眼压治疗研究中发生原发性开角型青光眼的基线危险因素研究

Higher baseline pattern standard deviation (PSD) and larger vertical cup to disk ratio (VC/D) were factors in the predictive model for the development of pr imary open angle glaucoma (POAG) in the Ocular Hypertension Treatment Study. Be cause early changes in PSD and VC/D may be indicative of early POAG damage, we r epeated the prediction model excluding PSD and VC/D. Reanalysis of baseline fact ors for the development of POAG. We compared the hazard ratios for baseline fact ors predictive of POAG in the multivariate Cox proportional hazards model that i ncluded PSD and VC/D and in the model that excluded them. Hazard ratios for base line factors predictive of POAG in Ocular Hypertension Treatment Study were not substantially affected by the inclusion or exclusion of PSD and VC/D in the prop ortional hazards model. Whether PSD or VC/D was included in the Cox proportional hazards model, the same baseline factors were statistically significant and the ir hazard ratios were essentially similar.