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1.
M Waisbourd B Lee M H Ali L Lu P Martinez B Faria A Williams M R Moster L J Katz G L Spaeth 《Eye (London, England)》2015,29(10):1321-1328
Purpose
To determine the sensitivity and specificity of various methods of detecting a relative afferent pupillary defect (RAPD) in patients with glaucoma-related diagnoses.Patients and methods
Patients underwent RAPD evaluation using the swinging flashlight method (SFM), the magnifier-assisted SFM, and pupillography using the Konan RAPDx. Main outcome measures were sensitivity and specificity of three methods of RAPD evaluation in detecting visual field mean deviation (MD), cup to disc ratio (CDR), disc damage likelihood scale (DDLS), and retinal nerve fiber layer (RNFL) asymmetry.Results
Eighty-one consecutive patients from the Wills Eye Hospital glaucoma service were enrolled, 60 with glaucoma and 21 with ocular hypertension or glaucoma suspect. Thirty-one percent of subjects had MD asymmetry>5 dB, 19.7% had CDR asymmetry≥0.20, 26.7% had DDLS asymmetry≥2, and 38.2% had RNFL asymmetry>10 microns. Sensitivity values for pupillography were 93.3% (95% CI, 68.1–99.8) for detecting MD asymmetry, 80.0% (95% CI, 51.9–95.7) for CDR asymmetry, 100.0% (95% CI, 73.5–100.0) for DDLS asymmetry, and 69.2% (95% CI, 38.6–90.9) for RNFL asymmetry. Specificity values were 41.2% (95% CI, 24.7–59.3) for detecting MD asymmetry, 32.8% (95% CI, 21.3–46.0) for CDR asymmetry, 33.3% (95% CI, 18.0–51.8) for DDLS asymmetry, and 42.9% (95% CI, 21.8–66.0) for RNFL asymmetry. Pupillography amplitude score was correlated with MD asymmetry (r2=0.41, P<0.001) and area under the curve was 0.84.Conclusion
Automated pupillography had higher sensitivity and lower specificity in detecting MD, CDR, DDLS, and RNFL asymmetry. Within the bounds of the cohort tested, this method had limited case-finding ability. 相似文献2.
Aim
To assess whether ophthalmic assistants are effective in screening people for glaucoma in India.Methodology
The study subjects were examined by both trained ophthalmic assistants and an ophthalmologist in both hospital and community settings. Specific tests for the diagnosis of glaucoma suspects included visual field examination using frequency doubling technology perimetry, intraocular pressure measurement (Tonopen), A-scan central anterior chamber depth measurement and dilated optic disc examination. The findings recorded by the ophthalmic assistants were masked to the ophthalmologist to avoid measurement bias.Results
In the hospital setting, there was a substantial level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (89.29%, k=0.7, 95% confidence interval (CI)=0.54–0.86). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was high for sensitivity (95.2%, 95% CI=91.4–97.7%) but lower for specificity at 71.4% (95% CI=60.0–78.7%).In the community setting, there was a moderate level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (78.23%, k=0.50, 95% CI=0.37–0.64). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was moderate for sensitivity (82.9, 95% CI=69.7–91.5%) but lower for specificity at 76.8% (95% CI=72.7–79.5%).Conclusion
Ophthalmic assistants can be used for opportunistic case detection of glaucoma suspects in the community. Structured training of the ophthalmic assistants together with enhanced clinical experience would improve their performance in detecting glaucoma suspects in the community. 相似文献3.
Purpose
To investigate the long-term visual field (VF) progression of temporally tilted disc and nontilted disc in normal tension glaucoma (NTG).Methods
Retrospective, observational case series. Forty-seven patients with temporally tilted disc (47 eyes), 44 patients with nontilted disc in NTG (44 eyes) patients, who were examined by at least 5 VF tests, and were followed-up over a 5-year period, at the Department of Ophthalmology of the Samsung Medical Center, from May 1998 to 2013. VF progression was defined by modified Anderson–Hodapp criteria, and Glaucoma Progression Analysis (GPA). Multivariate analysis was used to identify the risk factors for VF progression in the temporally tilted disc.Results
According to the Anderson–Hodapp criteria, progression rates of the temporally tilted disc and nontilted disc at 60 months were 19% and 72%, respectively (P<0.0001). According to GPA, they were 25% and 53%, respectively (P<0.0001). Twenty of 47 patients in the temporally tilted disc did not show progression. Among them, the more tilted disc showed the more VF defects. The hazard ratio of retinal nerve fiber layer (RNFL) defect type was 3.08 (95% CI, 1.17–8.14; P=0.02). The simultaneous superior and inferior RNFL defect type was the most common in progressors in the temporally tilted disc (P=0.04).Conclusion
Through long-term follow-up, the cumulative survival rate of temporally tilted disc was higher than that of nontilted disc. Caution is required in the treatment of the temporally tilted disc. New treatment policy for the temporally tilted disc may follow. 相似文献4.
Purpose
To describe the visual outcomes and morbidity of newly referred uveitis patients.Methods
Retrospective cohort study of 133 newly referred uveitis patients with active uveitis who required care in a tertiary center for at least 1 year. Main outcomes were best-corrected visual acuity (BCVA) at referral and 1 year after referral, duration of visual impairment, systemic medications used, as well as all complications and surgeries during the first year of follow-up. Generalized estimating equation models was used to assess prognosticators for poor BCVA.Results
The mean age at onset of uveitis was 43 years. The proportion of patients with at least one eye with BCVA ≤0.3 decreased from 35% at referral to 26% (P=0.45) at 1-year follow-up. The mean duration of visual impairment in the first year after referral was 4 months per affected eye. At 1-year follow-up, bilateral visual impairment was observed in 4% but at least one ocular complication developed in 66% and 30% of patients required at least one intraocular surgery. Systemic immunosuppressive treatment was required in 35% of patients and the mean number of visits to ophthalmologist was 11 per year, while 8% of patients required hospital admission. Prognosticators for poor visual outcome included surgery undergone before referral (odds ratio (OR), 3; 95% CI, 1–11; P=0.047), visual impairment at referral (OR, 21; 95% CI, 8–54; P<0.001), and glaucoma before referral (OR, 7; 95% CI, 2–28; P=0.007).Conclusions
Patients with severe uveitis had a favorable BCVA 1 year after referral with only 4% of patients having bilateral visual impairment. This, in contrast to the prolonged duration of visual impairment during the first year of follow-up and the demanding care. 相似文献5.
Purpose
To compare the results of silicone and polypropylene Ahmed glaucoma valves (AGV) implanted during the first 10 years of life.Methods
A prospective study was performed on 50 eyes of 33 patients with paediatric glaucoma. Eyes were matched to either polypropylene or silicone AGV. In eyes with bilateral glaucoma, one eye was implanted with polypropylene and the other eye was implanted with silicone AGV.Results
Fifty eyes of 33 children were reviewed. Twenty five eyes received a polypropylene valve, and 25 eyes received a silicone valve. Eyes implanted with silicone valves achieved a significantly lower intraocular pressure (IOP) compared with the polypropylene group at 6 months, 1 year, and 2 years postoperatively. The average survival time was significantly longer (P=0.001 by the log-rank test) for the silicone group than for the polypropylene group and the cumulative probability of survival by the log-rank test at the end of the second year was 80% (SE: 8.0, 95% confidence interval (CI): 64–96%) in the silicone group and 56% (SE: 9.8, 95% CI: 40–90%) in the polypropylene group. The difference in the number of postoperative interventions and complications between both groups was statistically insignificant.Conclusion
Silicone AGVs can achieve better IOP control, and longer survival with less antiglaucoma drops compared with polypropylene valves in children younger than 10 years. 相似文献6.
Purpose
To evaluate consistency among consultant ophthalmologists in registration of visual impairment of patients with glaucoma who had a significant visual field component to their visual loss.Method
Thirty UK NHS consultant ophthalmologists were asked to grade data sets comprising both visual acuity and visual fields as severely sight impaired, partially sight impaired, or neither. To assess intra-consultant agreement, a group of graders agreed to repeat the process.Results
Kappa for inter-consultant agreement (n=30) for meeting the eligibility criteria for visual impairment registration was 0.232 (95% CI 0.142–0.345), the corresponding inter-class correlation score was 0.2 (95% CI 0.172 to 0.344). Kappa for intra-consultant agreement (n=16) ranged from 0.007 to 0.9118.Conclusions
When presented with the clinical data necessary to decide whether patients with severe visual field loss are eligible for vision impairment registration, there is very poor intra- and inter-observer agreement among consultant ophthalmologists with regard to eligibility. The poor agreement indicates that these criteria are open to significant subjective interpretation that may be a source of either under- or over-registration of visual impairment in this group of patients in the UK. This inconsistency will affect the access of visually impaired glaucoma patients to support services and may result in inaccurate recording of the prevalence of registerable visual disability among glaucoma patients with severe visual field loss. More objective criteria with less potential for misclassification should be introduced. 相似文献7.
Purpose
To describe and measure the discriminatory performance of three new superior–inferior asymmetry indices for detecting primary open angle glaucoma (POAG) and to compare these with the glaucoma hemifield test (GHT).Methods
In all, 412 control and 247 POAG eyes were selected from a visual field database of patients attending the Manchester Royal Eye Hospital. Age-adjusted defect asymmetries were calculated for each of the 22 vertically mirrored test point pairs used in the GHT. The three new indices, hemifield mean difference (HMD) and hemifield standard deviation (HSD) of the asymmetry values along with the number of test pairs (NP) falling outside the 85% probability limits of the control population, were calculated. ROC curves of the indices and GHT were constructed. Agreement between the indices was explored with a proportional Venn diagram and 3 × 3 contingency tables. Cases of disagreement between the indices were reviewed.Results
The area under the ROC curves were HMD=0.745 (95% confidence interval (CI) 0.705–0.786), HSD=0.864 (95% CI 0.833–0.894), NP=0.863 (95% CI 0.832–0.893) and GHT=0.792 (95% CI 0.754–0.829). The Venn diagram and contingency tables highlighted the good agreement between HSD, NP and GHT. Agreement was 78% (HSD vs GHT) and 82% (NP vs GHT) in the control sample and 70% (HSD vs GHT) and 71% (NP vs GHT) in the POAG sample. Five cases are presented where disagreement existed between the indices.Conclusions
The new HSD and NP asymmetry indices perform better than GHT in differentiating between normal and POAG eyes in this data set. GHT can fail to detect significant asymmetry, detected by HSD and NP, when an early defect crosses sector boundaries. 相似文献8.
Aims
To evaluate the technique of eye drop instillation in patients with glaucoma and assess factors associated with a good technique.Methods
A cross-sectional observational study of 85 participants using self-administered topical medication for glaucoma or ocular hypertension. Patients were asked to demonstrate how they normally instil eye drops using a 5-ml bottle of sterile artificial tear solution. The procedure was recorded and assessed by two masked graders. Whether the patient had been previously shown how to instil drops, the number of eye medications used, and self-perceived difficulty of using drops were also recorded. Univariable logistic regression was performed to relate each variable to drop technique and variables with P<0.2 were included in a multivariable logistic regression analysis.Results
54.1% (46/85) of patients had a poor drop technique, 11.8% (10/85) missed the eye, 15.3% (13/85) touched the tip of the bottle to the bulbar conjunctiva or cornea, and 27.1% (23/85) touched the eyelid or lashes with the bottle tip. 81.2% (69/85) could not recall being shown how to instil eye drops. In the multivariable model, previous instruction regarding drop instillation technique was significantly associated with good technique (adjusted OR=8.17, 95% CI 2.02–33.05, P=0.003) and increasing age was associated with poor technique (adjusted OR=0.95, 95% CI 0.91–0.99, P=0.017).Conclusions
Education relating to eye drop instillation technique is significantly associated with a patient''s ability to instil drops correctly. The assessment of a patient''s ability to instil eye drops correctly should be a routine part of the glaucoma examination. 相似文献9.
Purpose
To evaluate the accuracy of different viewing monitors for image reading and grading of diabetic retinopathy (DR).Design
Single-centre, experimental case series—evaluation of reading devices for DR screening.Method
A total of 100 sets of three-field (optic disc, macula, and temporal views) colour retinal still images (50 normal and 50 with DR) captured by FF 450 plus (Carl Zeiss) were interpreted on 27-inch iMac, 15-inch MacBook Pro, and 9.7-inch iPad. All images were interpreted by a retinal specialist and a medical officer. We calculated the sensitivity and specificity of 15-inch MacBook Pro and 9.7-inch iPad in detection of DR signs and grades with reference to the reading outcomes obtained using a 27-inch iMac reading monitor.Results
In detection of any grade of DR, the 15-inch MacBook Pro had sensitivity and specificity of 96% (95% confidence interval (CI): 85.1–99.3) and 96% (95% CI: 85.1–99.3), respectively, for retinal specialist and 91.5% (95% CI: 78.7–97.2) and 94.3% (95% CI: 83.3–98.5), respectively, for medical officer, whereas for 9.7-inch iPad, they were 91.8% (95% CI: 79.5–97.4) and 94.1% (95% CI: 82.8–98.5), respectively, for retinal specialist and 91.3% (95% CI: 78.3–97.1) and 92.6% (95% CI: 81.3–97.6), respectively, for medical officer.Conclusion
The 15-inch MacBook Pro and 9.7-inch iPad had excellent sensitivity and specificity in detecting DR and hence, both screen sizes can be utilized to effectively interpret colour retinal still images for DR remotely in a routine, mobile or tele-ophthalmology setting. Future studies could explore the use of more economical devices with smaller viewing resolutions to reduce cost implementation of DR screening services. 相似文献10.
Purpose
Previous epidemiologic studies that focused on the association between open-angle glaucoma (OAG) and dementia showed inconsistent results. In the present study, we explored the association between OAG and dementia in an ethnic Chinese (ie, Taiwanese) population using a population-based data set.Methods
We retrieved data on study subjects for this case-control study from the Longitudinal Health Insurance Database 2000. We identified 7770 patients who had a diagnosis of dementia as cases, and 7770 subjects matched in terms of sex and age, which were randomly extracted as controls. A conditional logistic regression conditioned on age group, sex, and index year was used to assess the association of dementia with previously diagnosed OAG among the sampled patients.Results
Of 15 540 patients, 1.70% had prior OAG, including 2.02% of the dementia group and 1.38% of the controls. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, dementia patients were more likely to have had prior OAG than controls (odds ratio (OR): 1.44; 95% confidence interval (CI): 1.12–1.85; P<0.01). In addition, female dementia patients were more likely to have had prior OAG than controls (OR: 1.93; 95% CI: 1.35–2.77; P<0.001), whereas no statistical difference in prior OAG between male dementia patients and controls was found.Conclusions
Female dementia patients were associated with a higher proportion of prior OAG than were the controls. 相似文献11.
Purpose
Among some local side effects of prostaglandin-associated periorbitopathy (PAP), deepening of the upper eyelid sulcus (DUES) is the most prominent clinical feature, and is one of the most significant adverse cosmetic events. Here, we prospectively investigated the incidence of DUES in Japanese open-angle glaucoma patients initially treated with latanoprost (Xalatan 0.005%) ophthalmic solution.Methods
This was an open-label prospective study. Facial photographs and subjective reports of the recognition of DUES were obtained at the beginning of latanoprost treatment and at 2, 4, and 6 months thereafter. Intraocular pressure (IOP) was measured at three consecutive visits before and after treatment with latanoprost. The incidence of DUES was evaluated objectively by three blinded investigators who compared the series of photographs.Results
A total of 52 eyes of 52 newly diagnosed open-angle glaucoma Japanese patients (28 males, 24 females) were evaluated. The objective rate of DUES was 1/52 (2% 95% CI 0.05 to 10.7%) at 2 months, 2/52 (4% 95% CI 0.5 to 13.9%) at 4 months, and 3/52 (6% 95% CI 1.2 to 16.9%) at 6 months. During this period, no patient self-reported an occurrence of DUES. Mean IOPs before and after treatment were 16.5±2.9 and 13.8±3.0 mm Hg, respectively. Latanoprost reduced the IOP significantly (P<0.0001, paired t-test).Conclusions
Latanoprost caused DUES rarely and had a robust IOP-lowering effect in Japanese glaucoma patients. 相似文献12.
F Bochmann A Kipfer J Tarantino C Kaufmann L Bachmann M Thiel 《Eye (London, England)》2014,28(10):1184-1189
Purpose
The aim of this study was to assess whether intraoperative testing of silicone Ahmed glaucoma valves (AGVs) would identify valves with an increased risk of low postoperative intraocular pressure (IOP).Methods
In 30 consecutive cases of glaucoma surgery with AGV implantation, after priming the AGV, we intraoperatively measured the opening pressure A, closing pressure B, and re-opening pressure C using the active infusion pump of a phako-machine. IOP was checked postoperatively on the same day. Low IOP was defined as <5 mm Hg. Intraoperatively measured pressure characteristics of the valve function were analysed for their ability to predict postoperative IOP outcomes.Results
Opening A, closing B, and re-opening C pressures (mean, (SD)) were 18.4 (5.1), 8.3 (4.7), and 11.7 (4.8)mm Hg, respectively. Ten patients (33.3%) had low IOP. An opening pressure of ≤18 mm Hg predicted low postoperative IOP with a sensitivity (10/10) of 100% (95% CI, 69.2–100) and a specificity (13/20) of 65.0% (95% CI, 40.8–84.6).Conclusions
AGVs have a high variability of opening, closing, and re-opening pressures. An opening pressure of ≤18 mm Hg, a closing pressure of ≤10 mm Hg, or a re-opening pressure of ≤11 mm Hg identified all patients with low postoperative IOP. 相似文献13.
Purpose
Anatomically, the eyes and paranasal sinuses are neighboring structures and some studies have mentioned eye disease in conjunction with chronic rhinosinusitis (CRS). However, to the best of our knowledge, no prior research has investigated the risk of developing open-angle glaucoma (OAG) among CRS patients. This study aims to provide an estimated risk of developing OAG among patients with CRS by using a population-based data set in Taiwan.Methods
This retrospective cohort study used data sourced from the ‘Longitudinal Health Insurance Database 2000''. A total of 15 642 CRS patients were included in the study cohort and 46 926 subjects were randomly extracted as a comparison cohort. A cox proportional-hazards regression analysis was performed to calculate the 5-year risk of subsequently developing OAG following a diagnosis of CRS between the study cohort and the comparison cohort.Results
The incidence rate of developing OAG over the 5-year follow-up period was 5.45 (95% CI: 4.95–5.98) per 1000 person-years for the study cohort and 2.80 (95% CI: 2.60–3.03) per 1000 person-years for the comparison cohort. After censoring the cases that died over the 5-year period and adjusting for the factors of monthly income, geographic region, hypertension, diabetes, coronary heart disease, hyperlipidemia, and hypothyroidism the hazard ratio for developing OAG over the 5-year period for subjects with CRS to subjects without CRS was 1.73 (95% CI: 1.53–1.96).Conclusion
We found that those subjects with CRS had a significantly higher risk of developing OAG over the 5-year follow-up period as compared with subjects without CRS. 相似文献14.
Background
Glaucoma referrals continue to impart a significant burden on Hospital Eye Services (HES), with a large proportion of these false positives.Aims
To evaluate the Portsmouth glaucoma scheme, utilising virtual clinics, digital technology, and community optometrists to streamline glaucoma referrals.Method
The stages of the patient trail were mapped and, at each step of the process, 100 consecutive patient decisions were identified. The diagnostic outcomes of 50 consecutive patients referred from the refinement scheme to the HES were identified.Results
A total of 76% of ‘glaucoma'' referrals were suitable for the refinement scheme. Overall, 94% of disc images were gradeable in the virtual clinic. In all, 11% of patients ‘attending'' the virtual clinic were accepted into HES, with 89% being discharged for community follow-up. Of referrals accepted into HES, the positive predictive value (glaucoma/ocular hypertension/suspect) was 0.78 vs 0.37 in the predating ‘unrefined'' scheme (95% CI 0.65–0.87). The scheme has released 1400 clinic slots/year for HES, and has produced a £244 200/year cost saving for Portsmouth Hospitals'' Trust.Conclusion
The refinement scheme is streamlining referrals and increasing the positive predictive rate in the diagnosis of glaucoma, glaucoma suspect or ocular hypertension. This consultant-led practice-based commissioning scheme, if adopted widely, is likely to incur a significant cost saving while maintaining high quality of care within the NHS. 相似文献15.
Aims
To validate a new photogrammetric technique for quantifying eye surface area and using this to quantify the degree of improvement in symmetry in patients with oral–ocular synkinesis following Botulinum toxin injection.Study design
Feasibility study and retrospective outcomes analysisMethods
Ten patients'' photographs were chosen from a photographic database. Their eye surface areas were measured independently by two raters using a graphics tablet. One rater repeated the procedure after 15 days. Bland–Altman plots were computed, ascertaining inter-rater and intra-rater variability. The eye surface areas of 19 patients were then derived from photographs taken before and after Botulinum toxin injections. Paired t-tests were used to analyse the significance of the difference in pre- and post-treatment symmetry.Results
Ninety per cent of eye surface areas derived from the two raters were within a coefficient of variation of 0.1 (95% CI: 0.05–0.15). Similarly, 90% of eye surface areas derived from one rater had a coefficient of variation of 0.08 (95% CI: 0.04–0.12). Botulinum toxin significantly reduced synkinesis resulting from lip puckering, Mona Lisa smiling and Hollywood smiling (P<0.05).Conclusions
We have proposed a clinically valid tool for quantifying the effects of Botulinum toxin treatment for oral–ocular synkinesis. We recommend this method be used to monitor the response of such patients when receiving Botulinum toxin treatment.Level of evidence
2c. 相似文献16.
Aims
To investigate if TSH-receptor antibody (TRAb) levels measured in early Graves'' orbitopathy (GO) stages are predictive of clinical disease course beyond 1 year after initial GO diagnosis and to compare performance of two newly developed TRAb assays (third-generation thyrotropin-binding inhibitor immunoglobulin (TBII) assay vs Mc4-thyroid-stimulating immunoglobulin (TSI) bioassay) in predicting disease course.Methods
Newly diagnosed, untreated GO patients whose duration of ocular symptoms was less than 6 months were included. One year after initial diagnosis, all patients were classified as presenting either a mild (Group 1) or severe course (Group 2) according to their clinical manifestations. The measurements of two TRAb assays at initial GO diagnosis were used for analysis.Results
Data from 112 patients were available for analysis. Seventy-three patients (65.2%) were designated as Group 1, and 39 patients (34.8%) as Group 2. Patients with higher initial TRAb levels demonstrated a higher risk of severe disease course upon multiple regression analysis (P<0.01). The cutoff values for the prediction of severe course of the third-generation TBII and Mc4-TSI assays were 10.67 IU/l and 555.10%, respectively, with assay specificities of 84.9 and 89.0%. The TBII assay predictive power (area under the curve (AUC)=0.817; 95% confidence interval (CI) =0.732–0.902) was equivalent to the TSI bioassay (AUC=0.868, 95% CI=0.803–0.934) (P=0.203).Conclusions
The predictive power of the third-generation TBII assay and Mc4-TSI bioassay are similarly strong. Measurement of TRAb using either third-generation TBII or Mc4-TSI in early GO periods would provide important prognostic information on future GO course. 相似文献17.
M G Uva T Avitabile M Reibaldi C Bucolo F Drago L Quaranta E Lionetti A Longo 《Eye (London, England)》2014,28(1):53-57
Purpose
To investigate the success (glaucoma control) of latanoprost therapy of primary congenital glaucoma (PCG) and factors affecting the long-term outcome.Methods
Patients with PCG treated with latanoprost were re-examined. At study visit and from clinical charts, we evaluated: intraocular pressure, length of glaucoma control with latanoprost, need of further medication or glaucoma surgery, systemic and topical side effects. Multivariate analysis was used to test factors related to the final outcome of the treatment.Results
Eighty-one eyes of 44 patients with PCG, and 42 eyes of 29 patients with previous glaucoma surgery, had received latanoprost therapy. In the first group, a success (glaucoma control by latanoprost therapy) was found in 24 eyes (29.6%), whereas 57 eyes (70.4%) had received surgery (45 eyes (55.6%) in the first year); among the eyes with previous surgery, a success was found in 12 eyes (28.6%), 13 eyes (31%) required an additional therapy, and 17 eyes (40.5%) had received further glaucoma surgery. No patient discontinued the treatment because of side effects. Factors related to the failure of the latanoprost treatment were: the high score of severity of glaucoma (P=0.014) and low age at PCG presentation (P=0.042).Conclusions
Long-term treatment with latanoprost is effective in about 30% of the eyes; factors related to failure were severe glaucomatous alterations, and young age at PCG presentation. 相似文献18.
M Sehi N Bhardwaj Y S Chung D S Greenfield Advanced Imaging for Glaucoma Study Group 《Eye (London, England)》2012,26(12):1527-1535
Purpose
The objective of this study is to assess whether baseline optic nerve head (ONH) topography and retinal nerve fiber layer thickness (RNFLT) are predictive of glaucomatous visual-field progression in glaucoma suspect (GS) and glaucomatous eyes, and to calculate the level of risk associated with each of these parameters.Methods
Participants with ≥28 months of follow-up were recruited from the longitudinal Advanced Imaging for Glaucoma Study. All eyes underwent standard automated perimetry (SAP), confocal scanning laser ophthalmoscopy (CSLO), time-domain optical coherence tomography (TDOCT), and scanning laser polarimetry using enhanced corneal compensation (SLPECC) every 6 months. Visual-field progression was assessed using pointwise linear-regression analysis of SAP sensitivity values (progressor) and defined as significant sensitivity loss of >1 dB/year at ≥2 adjacent test locations in the same hemifield at P<0.01. Cox proportional hazard ratios (HR) were calculated to determine the predictive ability of baseline ONH and RNFL parameters for SAP progression using univariate and multivariate models.Results
Seventy-three eyes of 73 patients (43 GS and 30 glaucoma, mean age 63.2±9.5 years) were enrolled (mean follow-up 51.5±11.3 months). Four of 43 GS (9.3%) and 6 of 30 (20%) glaucomatous eyes demonstrated progression. Mean time to progression was 50.8±11.4 months. Using multivariate models, abnormal CSLO temporal-inferior Moorfields classification (HR=3.76, 95% confidence interval (CI): 1.02–6.80, P=0.04), SLPECC inferior RNFLT (per −1 μm, HR=1.38, 95% CI: 1.02–2.2, P=0.02), and TDOCT inferior RNFLT (per −1 μm, HR=1.11, 95% CI: 1.04–1.2, P=0.001) had significant HRs for SAP progression.Conclusion
Abnormal baseline ONH topography and reduced inferior RNFL are predictive of SAP progression in GS and glaucomatous eyes. 相似文献19.
C H L Lim N A Carnt M Farook J Lam D T Tan J S Mehta F Stapleton 《Eye (London, England)》2016,30(3):447-455
Purpose:
To investigate independent risk factors for contact lens-related microbial keratitis in Singapore and estimate their impact on disease load.Methods:
Cases were contact lens wearers presenting to Singapore National Eye Centre with microbial keratitis between 2008 and 2010. Community contact lens wearers were recruited as controls. All wearers completed a previously validated questionnaire describing contact lens wear history, hygiene and compliance habits, and demographics. Risk factors significant in univariate analysis (P<0.2) were evaluated in a multivariate model.Results:
In all, 58 cases of microbial keratitis and 152 contemporaneous controls were identified. When controlling for other variables, Chinese had a 7 × lower risk compared with other races (95% CI: 2.3–21.3, P=0.001). Those aged between 25 and 44 years were at 3 × increased risk compared with younger wearers (95% CI: 1.1–9.6, P=0.04). Occasional overnight contact lens wear (less often than one night per week) was associated with a 4 × higher risk (95% CI: 1.2–15.4, P=0.03) compared with daily use. Not washing hands before handling was associated with a 13 × increased risk (95% CI: 1.9–84.8, P=0.008). Use of multipurpose solution A carried a 16 × higher risk compared with hydrogen peroxide (95% CI: 1.5–174.0, P=0.02). The combined PAR% for modifiable risk factors (occasional overnight wear, not washing of hands, and MPS A) was 82%.Conclusions:
Consistent with previous findings, independent risk factors for contact lens-related microbial keratitis include poor hand hygiene, occasional overnight wear, and type of lens care solution. Prolonged overnight or extended contact lens use was infrequent in this population. 相似文献20.