Strabismus surgery among aged medicare beneficiaries

OBJECTIVES: The purpose of this study was to investigate the incidence of strabismus surgery among aged patients in the United States. METHODS: The Medicare Part B claims experience (physician professional fee billing) for 1995 was reviewed for the number of times each strabismus surgical procedure recognized in Physicians' Current Procedural Terminology (CPT) was performed. To determine the indications for the procedures that were performed, a 5% sample of claims was reviewed for the pertinent International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic codes. RESULTS: There were 27 million aged Medicare beneficiaries eligible for Part B benefits in 1995 in a fee-for-service setting. During that year physicians reported 9497 strabismus physician services. These represented 6585 separate procedures (CPT codes 67311 to 67343) and 277 botulinum toxin (Botox) injections for strabismus (CPT 67345) performed during 1995. Sixty-nine percent of the surgical procedures were for horizontal correction and 28% were for vertical correction. Adjustable sutures were used for only 1240 cases (1 9%). The add-on procedural code for reoperation surgery or surgery in the presence of restriction of the extraocular muscles was used in just 930 cases (14%). The most common diagnosis for horizontal surgery was exotropia. Paralytic strabismus and thyroid disease were identified for 17% of cases. Three percent of the diagnoses were inappropriate for the procedures performed and may have been reported in error. CONCLUSIONS: These data confirm a very low incidence of strabismus surgical procedures (2/10,000) and injections (1/100,000) among aged Medicare beneficiaries. The strabismus surgery was most often performed to repair a horizontal deviation. The adjustable suture technique was used infrequently. These data may be extrapolated into the future to aid in determining the strabismus services that will be needed early in the next century.     

前房角镜检查在青光眼诊治中的作用

青光眼作为一类病情复杂、治疗难度较大的疾病,其有效的治疗在一定程度上依赖于正确的诊断和分类。前房角状态是区分各种不同类型青光眼的重要窗口,而前房角镜检查则是打开这扇窗口的“钥匙”。本文就前房角镜检查的常见误区、使用方法、注意事项,临床诊治青光眼时前房角镜检查的目的以及如何克服前房角镜检查的不足之处进行了详尽的讨论。     

Comparative evaluation of RetCam vs. gonioscopy images in congenital glaucoma

Purpose:

To compare clarity, exposure and quality of anterior chamber angle visualization in congenital glaucoma patients, using RetCam and indirect gonioscopy images.

Design:

Cross-sectional study Participants. Congenital glaucoma patients over age of 5 years.

Materials and Methods:

A prospective consecutive pilot study was done in congenital glaucoma patients who were older than 5 years. Methods used are indirect gonioscopy and RetCam imaging. Clarity of the image, extent of angle visible and details of angle structures seen were graded for both methods, on digitally recorded images, in each eye, by two masked observers.

Outcome Measures:

Image clarity, interobserver agreement.

Results:

40 eyes of 25 congenital glaucoma patients were studied. RetCam image had excellent clarity in 77.5% of patients versus 47.5% by gonioscopy. The extent of angle seen was similar by both methods. Agreement between RetCam and gonioscopy images regarding details of angle structures was 72.50% by observer 1 and 65.00% by observer 2.

Conclusions:

There was good agreement between RetCam and indirect gonioscopy images in detecting angle structures of congenital glaucoma patients. However, RetCam provided greater clarity, with better quality, and higher magnification images. RetCam can be a useful alternative to gonioscopy in infants and small children without the need for general anesthesia.     

Trends in glaucoma surgery before and after the introduction of new topical glaucoma pharmacotherapies

OBJECTIVE: Recent advances in pharmacotherapy that have improved the ability to effect sustained reductions in intraocular pressure may delay or obviate the need for surgery for open-angle glaucoma. This analysis explored this possibility by evaluating the frequency of surgeries for open-angle glaucoma in the US Medicare population before and after the 1996 introduction of latanoprost, a topical prostaglandin analogue with potent ocular antihypertensive efficacy and a better safety profile than older topical glaucoma medications. METHODS: Data from the Medicare 5% Standard Analytical File were used to develop national estimates of the frequency of glaucoma surgeries in the US yearly from 1994 through 1999. RESULTS: While the number of US Medicare patients with a diagnosis of glaucoma remained constant from 1994 through 1999, the number of inpatient and outpatient glaucoma surgeries declined with a particularly sharp drop between 1996 and 1997. In 1999 relative to 1994, the number of annual glaucoma surgeries among unique patients with a diagnosis of glaucoma was reduced by 72% for inpatient procedures and 42% for outpatient procedures. CONCLUSIONS: The number of glaucoma surgeries among US Medicare patients markedly decreased from 1994 to 1999, during which time the prevalence of glaucoma remained stable in this population. The decrease in surgeries coincided with the introduction of improved topical pharmacotherapies for the management of glaucoma. Although the ability to infer a causal relationship between introduction of new pharmacotherapy and the decrease in surgeries is limited, the consistency of these data with those of several other studies renders the findings compelling.     

青光眼麻痹性瞳孔散大的预防

目的 探讨如何预防青光眼术前术后麻痹性瞳孔散大的发生。方法 33例（56眼）青光眼，采用20％甘露醇注射液快速降低眼压，及1％毛果芸香碱滴眼液频繁滴眼。观察术前术后瞳孔情况。结果 术后2周全部病例未发生麻痹性瞳孔散大。结论 青光眼麻痹性瞳孔散大可以预防的。     

Use of cytostatic therapy with 5-fluorouracil in surgery of glaucoma

Possibilities, conditions and outlooks of using a 5% fluorouracil solution, as subconjunctival injections after antiglaucomatous interventions and as intraoperative applications in the trabecular area, were studied in 131 patients (143 eyes) with uncompensated developed and advanced glaucoma. The results of clinical examinations showed a high efficiency of using fluorouracil after antiglaucomatous interventions to ensure a long-lasting hypotensive effect. Two injections made in the early postoperative period did not entail any complications and were sufficient to maintain the surgical effect.     

Coding of glaucoma for patients with uveitis in the medicare database

PURPOSE: To investigate possible causes for, and implications of, variations in coding of glaucoma for patients with uveitis in the Medicare database. PATIENTS AND METHODS: We identified 6,391 patients coded with one of several ICD-9 codes designating a form of uveitis from a 5% sample of the 1999 Medicare database. The proportion of patients with uveitis codes who also had codes for uveitic glaucoma, primary open-angle glaucoma (POAG), or unspecified open-angle glaucoma (OAG) were determined. The proportion with codes for argon laser trabeculoplasty (ALT), trabeculectomy, visual field examinations, fundus photographs, and gonioscopy were calculated in three groups: patients with both uveitis and uveitic glaucoma; those with both uveitis and POAG; and those with both uveitis and unspecified open-angle glaucoma. Summaries of the total allowed reimbursement related to eye visits and to eye codes were determined. RESULTS: Of the 6,391 patients with uveitis who were studied, 1,260 (19.7%) also had the code for POAG; 412 (6.4%) had the code for OAG; and 117 (1.8%) had the code for uveitic glaucoma. Visual field testing was less common among patients with uveitic glaucoma (37%) than among those with POAG/uveitis (46%) or OAG/uveitis (44%) (P < 0.001). There were no statistically significant differences among the three groups in the amount of total reimbursement related to eye services or eye codes. CONCLUSIONS: The code for POAG appears to be used in lieu of uveitic glaucoma in many cases. Discrepancies are probably not influenced by expected reimbursements, as much as by a lack of understanding about the available ICD-9 codes.     

Goniodysgenesis in elderly glaucoma and non-glaucoma patients. A masked slit-lamp and gonioscopy study

The aim was to elucidate whether goniodysgenesis is more frequently observed in elderly patients with glaucoma, and furthermore, which signs of goniodysgenesis are of importance and most unanimously detected. Thus, 3 examiners evaluated 21 glaucoma patients and 19 non-glaucoma patients in a masked fashion. None of the patients had a first-degree heredity. Gonioscopy, slit-lamp examination and measurements of the corneal and pupillary diameter were performed, in all 26 variables. Significantly (P less than 0.05) more frequent in glaucoma were an increased corneal diameter, scleral overriding, hypoplasia of the pupillary seam, abnormal Schwalbe's line and an opaque pretrabecular membrane (one examiner). Less frequent were a peripupillary yellow pigment ring and pigment stars on the lens. Inter-observer variation was small regarding e.g. corneal diameter but rather large regarding e.g. the pretrabecular membrane.