Refractive errors,intraocular pressure,and glaucoma in a white population

OBJECTIVE: To examine the relation of refractive errors to glaucoma and intraocular pressure (IOP) in a defined white population. DESIGN: Population-based cross-sectional and follow-up study. PARTICIPANTS: Persons aged 43 to 86 years living in Beaver Dam, Wisconsin (n = 4926). METHODS: All participants received a standardized assessment of refraction, IOP, and glaucoma at baseline (1988-1990), with IOP remeasured 5 years later (1993-1995). Refraction was defined at baseline as follows: myopia as spherical equivalent of -1.00 diopters (D) or less, emmetropia as -0.75 to +0.75 D, and hyperopia as +1.00 D or more. MAIN OUTCOME MEASURES: Relation of baseline refraction to prevalent glaucoma (defined from IOP, optic disc, and visual field criteria) and incident ocular hypertension (defined as IOP more than 21 mmHg at the 5-year examination in eyes with IOP of 21 mmHg or less at baseline). RESULTS: A myopic refraction was correlated with increasing IOP at baseline (P < 0.001). After controlling for age and gender, persons with myopia were 60% more likely to have prevalent glaucoma than those with emmetropia (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1, 2.3). In contrast, controlling for age, gender, and baseline IOP, persons with hyperopia were 40% more likely to have incident ocular hypertension than those who were emmetropic at baseline (OR, 1.4; 95% CI, 1.0, 2.0). Myopia was not related to incident ocular hypertension. CONCLUSIONS: In these population-based data, there was a cross-sectional association of myopia with higher IOP and prevalent glaucoma. Similar associations have been found in previous studies. Hyperopia may be associated with 5-year risk of ocular hypertension, a finding that needs further investigation.     

Incidence of diabetic retinopathy in the Barbados Eye Studies

PURPOSE: To examine the 4-year incidence and risk factors for diabetic retinopathy (DR) among black participants with diabetes in the Barbados Eye Studies (BES). DESIGN: Population-based incidence study. SETTING AND PARTICIPANTS: Four hundred ten persons with diabetes mellitus (DM) from the BES cohort, which was based on a simple random sample of Barbadians, 40 to 84 years of age at baseline. MAIN OUTCOME MEASURES: Development of DR, assessed by independent gradings of 30 degrees color stereo fundus photographs of the disc and macula. Associations were evaluated by logistic regression analyses. RESULTS: After 4 years, DR developed in 92 of 306 (30.1%; 95% confidence interval, 25.0%, 35.5%) persons unaffected at baseline. The incidence of DR was 31.9% in those with known DM at baseline and 20.9% in newly diagnosed DM. Clinically significant macular edema developed in 16 (4.5%) of 353 individuals at risk. Seven (6.9%) of the 101 persons with minimum or moderate DR at baseline progressed to proliferative DR. Age-specific incidence declined from 36.2% at age 40 to 49 years to 28.8% and 24.2% over the subsequent two decades, increasing to 38.2% among those >/=70 years. Risk factors for DR were increased systolic blood pressure (relative risk [RR], 1.16 [1.03, 1.31]/10 mmHg increase); use of oral hypoglycemics (RR, 2.4 [1.3, 4.2]); and use of insulin (RR, 6.1 [1.7, 22.1]) (vs. no treatment or diet only); and elevated glycated hemoglobin (GHb; RR, 6.4 [2.5, 16.0]); GHb >11.5% vs. GHb 相似文献   

Intraocular pressure lowering efficacy of travoprost

PURPOSE: To assess the intraocular pressure lowering effect of travoprost 0.004% in patients previously treated with another topical medication, and in previously untreated patients. METHODS: This 12-week, open-label trial in 1590 patients was conducted at 219 sites in Switzerland. Primary open-angle glaucoma and ocular hypertension patients discontinued prior medications, and instilled 1 drop of travoprost in each affected eye at 8 pm. Untreated patients were subdivided into 2 groups: baseline IOP of > or = 21 mmHg, and baseline IOP of < or = 20 mmHg. Patients returned for follow-up visits at 1 and 3 months. The primary outcome was mean IOP change from baseline to follow-up. RESULTS: Of 626 patients previously on monotherapy, and 525 previously untreated or newly-diagnosed patients, 479 and 423, respectively, completed 3 months of therapy. The mean changes from baseline at 1 month (mmHg +/- SD), by prior treatment group were: beta blocker, -4.9 (+/- 3.6); latanoprost, -2.3 (+/- 2.8); alpha-agonist, -4.0 (+/- 3.7); dorzolamide/timolol fixed combination, -3.4 (+/- 3.9); topical CAI, -4.4 (+/- 3.1); new IOP > or = 21 mmHg, -8.6 (+/- 4.4); new IOP < or = 20 mmHg, -4.4 (+/- 3.0). (All changes from baseline were statistically significant (p < 0.0001). CONCLUSIONS: In patients previously treated with a single drug, travoprost decreased IOP to pressures below those achieved on prior therapy. In all groups, travoprost reduced mean IOP below 18 mmHg within 1 month of starting therapy, and control was maintained for at least 3 months. Overall, travoprost was safe and well-tolerated.     

A double-masked, randomized clinical trial comparing latanoprost with unoprostone in patients with open-angle glaucoma or ocular hypertension

PURPOSE: To compare the intraocular pressure (IOP) reducing effect and safety of latanoprost 0.005% once daily with unoprostone 0.12% twice daily in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH). DESIGN: An 8-week, double-masked, randomized, parallel-group, single-center clinical trial. PARTICIPANTS: A total of 108 patients with POAG or OH were enrolled. INTERVENTIONS: After completing a wash-out of ocular hypotensive medications, patients were randomized to receive either latanoprost once daily in the evening plus placebo once daily in the morning, or unoprostone twice daily (morning and evening). MAIN OUTCOME MEASURES: IOP was measured at 10:00 AM and at 5:00 PM at baseline and at week 8, and before 12:00 noon at week 2. Ocular and systemic safety assessments were performed. RESULTS: From an overall baseline of 24.1 mmHg, latanoprost reduced IOP by 6.7 mmHg (28%) and unoprostone reduced IOP by 3.3 mmHg (14%). The difference between the groups of 3.4 mmHg was significant (P: < 0.001, analysis of covariance; 95% confidence interval [CI]: -4.7 to -2.1) in favor of latanoprost. A >/=30% reduction in mean IOP from baseline was achieved by 44% of latanoprost-treated patients compared with 8% of unoprostone-treated patients. The incidence of adverse events was low and comparable between the groups. CONCLUSIONS: Latanoprost administered once daily was significantly more effective in reducing IOP compared with unoprostone administered twice daily in patients with POAG and OH.     

Predictive factors of successful selective laser trabeculoplasty in open-angle glaucoma

BACKGROUND: The aim of this study was to determine factors that predict successful selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG). PATIENTS AND METHODS: In 122 eyes suffering from OAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66, 72, 78 and 84 months thereafter. Success was defined as an IOP reduction exceeding 20 % of the pretreatment IOP. Correlations between successful SLT and baseline IOP, age, sex, hypertension, diabetes mellitus, family history of glaucoma, previous anterior segment surgery, the grade of trabecular meshwork pigmentation, laser energy used, and local antiglaucoma therapy were determined. RESULTS: The mean follow-up time was 43.4 months (SD: 25.6). The mean pretreatment IOP was 22.5 mmHg (SD: 2.8). The success rate after 12 months determined from the Kaplan-Meier survival analysis was 88 %, after 24 months 79 %, after 36 months 67 %, after 48 months 58 %, after 60 months 49 % and after 84 months 48 %. We found statistically significant negative correlation betweens successful SLT and the grade of trabecular meshwork pigmentation (r = -0.234; p = 0.01), diabetes mellitus (r = -0.223; p = 0.014). We found no statistically significant correlations between successful SLT and baseline IOP, age, sex, hypertension, family history of glaucoma, previous anterior segment surgery, laser energy used, local antiglaucoma therapy. CONCLUSION: SLT success in OAG with a mean follow-up time of 43.4 months was significantly predicted by the lower grade of trabecular meshwork pigmentation and the absence of diabetes mellitus.     

中老年人高血压和糖尿病与年龄相关性白内障的关系

目的：探讨中老年人高血压、糖尿病与年龄相关白内障（age-relatedcataract,ARC）危险性之间的关系。方法：采用以医院为基础的病例对照研究方法。病例由45～85岁的360例因患ARC施行白内障手术摘除的患者组成,对照由同期入住相同医院的360例非白内障患者组成,采取1∶1匹配。采用标准调查表对研究对象进行面对面调查,内容包括人口学特征、生活方式、疾病既往史等,同时对血压、血糖进行测量。应用多因素Logistic回归分析估计高血压及糖尿病与ARC关联的比值比（OR）及其相应的95%可信区间（CI）。结果：在调整了年龄和性别因素后,高血压与ARC呈显著正相关（OR=1.573,P=0.005）。与收缩压正常者相比较,收缩压≥180mmHg者发病的危险性增加（OR=2.812,95%CI：1.450～5.455,P=0.002）。高血压病程10a～的研究对象发病的危险性显著地高于病程〈10a者（OR=1.867,95%CI：1.053～3.307,P=0.033）。同样,与非糖尿病患者相比,糖尿病患者发生ARC的危险性显著升高（OR=2.151,95%CI：1.470～3.149,P〈0.001）。与非糖尿病患者相比,糖尿病病程〈10a和10～19a者发生ARC的OR分别为2.374（95%CI：1.502～3.752,P〈0.001）和2.683（95%CI：1.267～5.683,P=0.010）。结论：ARC患病率增高与高血压、糖尿病及其病程增加有关。对这些可变危险因素采取干预性措施,尤其是对高危人群,可能意味着对ARC导致的视觉障碍必须采取控制性措施,因为此症是全球致盲的首要原因。     

Risk factors for incident nuclear opacities

PURPOSE: To evaluate risk factors for the 4-year incidence of nuclear opacities. DESIGN: Population-based cohort study (85% participation at 4-year follow-up). PARTICIPANTS: Two thousand six hundred nine black participants of the Barbados Eye Studies, without any nuclear opacities at baseline. METHODS: Participants completed a standardized protocol at baseline and follow-up, including ophthalmic and other measurements, an interview, slit-lamp lens grading, fundus photography, and an ophthalmologic examination. Factors associated with the incidence of nuclear opacities (Lens Opacities Classification System II N > or = 2) were evaluated by logistic regression. MAIN OUTCOME MEASURE: Relative risks (RR) with 95% confidence intervals (95% CI). RESULTS: The 4-year incidence of nuclear opacities was 9.2% (241 of 2609) and increased greatly with age. Women were at significantly greater risk (RR = 1.8), as were persons with darker iris color (RR = 4.9), myopia (RR = 2.8), history of diabetes (RR = 1.6), leaner body mass (RR = 0.95 for each unit increase in body mass index [kg/m(2)]), and intraocular pressure (IOP)-lowering treatment (RR = 2.7), mainly with topical beta-blockers. Treated participants had a threefold RR of nuclear opacities (RR = 3.2; 95% CI, 1.6, 6.5) compared with those untreated and with IOP < or =21 mmHg. Among participants with IOP >21 mmHg, those receiving treatment (n = 33) had a fivefold RR (RR = 5.0; 95% CI, 1.7, 15.1) versus those who were untreated. The RR was similar for treated persons with and without open-angle glaucoma (RR = 3.1; 95% CI, 1.3, 7.4 and RR = 2.8; 95% CI, 0.9, 8.6 respectively) but was lower in persons with newly detected (and thus untreated) glaucoma at baseline (RR = 1.2; 95% CI, 0.6, 2.6) compared with those without open-angle glaucoma or treatment. CONCLUSIONS: The 4-year risk of nuclear opacities increased with age, female gender, darker iris color, myopia, diabetes, and leaner body mass, indicating similarities with other populations. The use of topical IOP-lowering medications tripled the RR of nuclear opacities in this study, an association that requires verification from clinical trials.     

Diabetes,hypertension, and central obesity as cataract risk factors in a black population: The Barbados Eye Study

ObjectiveThe increased cataract prevalence of black populations, especially of cortical cataract, remains unexplained. The authors evaluate the relationships of diabetes, hypertension, and obesity patterns to lens opacities, by age, among 4314 black participants in the Barbados Eye Study.Design and participantsPrevalence study of a random sample of the Barbados population, ages 40 to 84 years (84% participation).Main outcome measuresAssociations with age-related lens changes (grade ≥2 in the Lens Opacities Classification System II at the slit lamp) were evaluated in logistic regression analyses by age (persons <60 years and ≥60 years). Results are presented as odds ratios (OR) with 95% confidence intervals.ResultsOf the 1800 participants with lens changes, most had cortical opacities. Diabetes history (18% prevalence) was related to all lens changes, especially at younger ages (age <60 years: OR = 2.23 [1.63, 3.04]; age ≥60 years: OR = 1.63 [1.22, 2.17]). Diabetes also increased the risk of cortical opacities (age <60 years: OR = 2.30 [1.63, 3.24]; age ≥60 years: OR = 1.42 [1.03, 1.96]); additional risk factors were high diastolic blood pressure (age <60 years: OR = 1.49 [1.00, 2.23]) and higher waist/hip ratio (all ages: OR = 1.36 [1.00, 1.84]). Diabetes was also related to posterior subcapsular opacities. Glycated hemoglobin levels were positively associated with cortical and posterior subcapsular opacities. Overall, 14% of the prevalence of lens changes could be attributed to diabetes.ConclusionsThe high prevalence of cortical opacities was related to diabetes, hypertension, and abdominal obesity, which also are common in this and other black populations. Interventions to modify these risk factors, especially in populations in which they are highly prevalent, may have implications to control visual loss from cataract, which is the first cause of blindness worldwide.     

Intraocular pressure reduction with a fixed treatment protocol in the Early Manifest Glaucoma Trial

Purpose: To evaluate: (i) the relationship between intraocular pressure (IOP) reduction attained with a fixed treatment protocol and the untreated IOP level; (ii) the consistency of IOP reduction over time; and (iii) whether there is a threshold pretreatment IOP level below which IOP reduction might be less effective. Results are based on 128 patients with glaucoma with field defects, who were randomized to the treatment arm of the Early Manifest Glaucoma Trial (EMGT). Methods: The EMGT fixed treatment protocol consisted of 360° laser trabeculoplasty and topical betaxolol eye drops B.I.D. Treatment was unchanged as long as progression did not occur. Analyses assessed the initial IOP reduction after 3 months and also the mean reduction based on all follow‐up values; IOP changes over time were evaluated with linear regression analysis. Factors influencing initial and mean IOP reduction were also explored using linear models. Results: Mean age at baseline was 68 years, and untreated baseline IOP ranged from 13 to 30.5 mmHg. On average, eyes with higher baseline IOP experienced larger pressure reductions than eyes with lower baseline IOP, whether expressed in mmHg or as percentages. Each mmHg of higher baseline IOP was associated with approximately 0.6 mmHg larger IOP reduction. IOP changed little over time, with 66% of patients changing less than 0.5 mmHg/year, and only 13% (17/128) changing >1.0 mmHg/year. The treatment protocol did not achieve any average IOP reduction in eyes with baseline pressures ≤ 15 mmHg. Factors related to more IOP reduction at 3 months were higher baseline IOP and positive refractive error, while higher baseline IOP and male gender (more reduction) and cardiovascular disease history (less reduction) were associated with mean IOP on treatment. Conclusion: With a fixed treatment protocol, the IOP reduction achieved depended very strongly on baseline untreated IOP levels. There seemed to be a lower threshold around 15 mmHg, where therapy did not result in any reduction of IOP. Our results suggest that when effects of IOP‐lowering treatment are reported, whether expressed in mmHg or as a percentage of untreated pressure levels, the baseline IOP levels should be specified as well.     

Five-year incidence and progression of vascular retinopathy in persons without diabetes: the Blue Mountains Eye Study

PURPOSE: To assess the 5-year incidence of vascular retinopathy and its associations in an older nondiabetic population. METHODS: The Blue Mountains Eye Study examined 3654 residents aged 49+ years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999. Retinopathy lesions (microaneurysms, haemorrhages, hard or soft exudates) were assessed from 6-field retinal photographs in persons without diabetes. Incident retinopathy was assessed in those at risk. Hypertensive status was defined following the WHO/International Society of Hypertension guidelines. RESULTS: Of the 2335 re-examined, 195 had retinopathy lesions at baseline and 1725 were at risk of retinopathy after excluding subjects with diabetes (n=261), retinal vein occlusion (n=52) or missing/un-gradable photographs (n=102). The cumulative 5-year incidence was 9.7% (95% confidence intervals (CI) 8.3-11.1%). Age was the only factor significantly associated with incident retinopathy (Pfor trend=0.012). Neither fasting blood glucose (age-sex-adjusted P=0.147) nor hypertension (adjusted Pfor trend=0.43) was associated with incident retinopathy. Of the 195 with retinopathy lesions at baseline, 3.5% developed diabetes, 13.3% progressed, and 72.3% regressed/disappeared over 5 years. Progression was positively associated with elevated blood pressure (BP) (adjusted odds ratio (OR) 1.3, 95% CI 1.1-1.6 per 10 mmHg systolic BP) and inversely associated with fasting glucose level (OR 0.36, CI 0.14-0.92 per mmol/l increase). Aspirin use was weakly associated with regression (OR 2.4, CI 1.0-6.0). CONCLUSIONS: Over 5 years, retinopathy developed in 10% of older people without diabetes, while 72% of baseline lesions regressed. Age was significantly associated with the development of these lesions.     

Silicone punctal plugs as an adjunctive therapy for open‐angle glaucoma and ocular hypertension

Background: Primary open‐angle glaucoma is a progressive optic neuropathy that can cause an irreversible loss of vision. A reduction in intraocular pressure (IOP) is beneficial in slowing or halting its progression. Once‐per‐day monotherapy glaucoma medications, such as prostaglandin analogues, are effective in lowering IOP while maintaining patients' adherence. Achieving the desired target IOP often requires multiple medications. The present study evaluates punctal occlusion of both the inferior and superior puncta as an adjunctive therapy to travoprost ophthalmic solution 0.004% for patients with primary open‐angle glaucoma or ocular hypertension in order to reduce IOP. Methods: Thirteen patients who were using travoprost 0.004% ophthalmic solution for the treatment of open‐angle glaucoma or ocular hypertension received silicone punctal plugs in the superior and inferior puncta of one eye. After one month, the IOP was remeasured. The percentage change of the IOP from the baseline was analysed by using a paired sample t‐test. Results: The mean baseline IOP was 19.82 ± 1.19 mmHg in the test eyes and 18.32 ± 1.11 mmHg in the control eyes. The mean IOP at the one‐month visit was 18.23 ± 1.17 mmHg in the test eyes and 18.45 ± 1.04 mmHg in the control eyes. The test eyes demonstrated a decrease in IOP of 1.59 (± 0.95) mmHg from the baseline, or a 6.82 per cent decrease in the IOP from the baseline. The control eyes had an increase in IOP of 0.14 ± 0.77 mmHg from the baseline, or a 1.91 per cent increase in the IOP. The relative difference in the IOP between the test eyes and the control eyes at the one‐month visit was 1.73 mmHg, or 8.74 per cent. Conclusion: Based on the results of this study, punctal occlusion offers a statistically and clinically significant decrease in IOP when it is used as an adjunctive therapy to travoprost 0.004% for patients who are suffering from open‐angle glaucoma or ocular hypertension.     

A comparison of the fixed combination of latanoprost and timolol with its individual components

PURPOSE: To evaluate the intraocular pressure (IOP)-reducing effect of the fixed combination of 0.005% latanoprost and 0.5% timolol compared with the individual monotherapies. METHODS: A 6-month, randomised, double-masked, controlled multicentre study followed by 6 months of open-label treatment was carried out in patients with glaucoma or ocular hypertension with pre-enrolment IOP >/=25 mmHg on glaucoma medication or >/=30 mmHg if untreated. Following a 2- to 4-week run-in period on timolol twice daily, 436 patients were randomised: 140 to fixed combination therapy once daily in the morning, 147 to latanoprost once daily in the morning and 149 to timolol twice daily. During the open-label extension, patients received fixed combination drug once daily in the morning. RESULTS: The difference in mean change from baseline in diurnal IOP from week 2 to week 26 was -1.2 mmHg between fixed combination and latanoprost (95% confidence interval. CI: -1.8 to -0.5; P<0.001; repeated-measures analysis of covariance). The corresponding difference between fixed combination and timolol was -1.9 mmHg (95% CI -2.5 to -1.2; P<0.001). No long-term drift in IOP was detected in patients treated for 12 months with fixed combination. All treatments were well tolerated with no major differences among groups in the incidence of clinically relevant adverse events. CONCLUSION: The fixed combination of 0.005% latanoprost and 0.5% timolol administered once daily in the morning for 6 months was more effective in reducing IOP than the individual components alone and was effective over 12 months.     

Efficacy and tolerability of the dorzolamide 2%/timolol 0.5% combination (COSOPT) versus 0.005% (XALATAN) in the treatment of ocular hypertension or glaucoma: results from two randomized clinical trials

PURPOSE: To compare the efficacy of the fixed dorzolamide 2%/timolol 0.5% combination (COSOPT) versus latanoprost 0.005% (XALATAN). METHODS: Two 3-month, parallel group, randomized, observer-masked and patient-masked, multicentre, clinical trials were performed in patients with ocular hypertension or open-angle glaucoma. Study 1 (n=256) was conducted in the United States and Study 2 (n=288) was conducted in Europe/Israel. Patients could be included whether or not they were currently taking ocular hypotensive therapy, and regardless of the effectiveness of any previous therapy. Patients were washed out from their usual ocular hypotensive medications and then those with a baseline intraocular pressure (IOP) >/= 24 mmHg were randomized to either the dorzolamide/timolol combination eye drops twice daily or latanoprost eye drops once daily in both eyes. Efficacy was assessed by daytime diurnal IOP (the mean of measurements made at 0800, 1000, 1400 and 1600 h). RESULTS: At baseline, the mean daytime diurnal IOP was 26.1 mmHg in the dorzolamide/timolol combination group versus 25.6 mmHg in the latanoprost group in Study 1, and 25.3 mmHg in the dorzolamide/timolol combination group versus 24.7 mmHg in the latanoprost group in Study 2. After 3 months, the mean daytime diurnal IOP was 18.9 mmHg for the dorzolamide/timolol combination versus 18.4 mmHg for latanoprost in Study 1, and 17.4 mmHg for the dorzolamide/timolol combination versus 17.5 for latanoprost in Study 2. The difference between treatments in mean IOP change at 3 months was -0.04 mmHg [95% confidence interval (CI) -0.85, 0.77] in Study 1, and -0.57 mmHg (95% CI -1.31, 0.16) in Study 2. The probability that the true difference lay between -1.5 and 1.5 mmHg, the predefined bounds for equivalence, was >0.950 in both studies. Both treatments were well tolerated over 3 months, although ocular stinging occurred more frequently with the dorzolamide/timolol combination. CONCLUSIONS: The dorzolamide/timolol combination and latanoprost were equally effective at lowering IOP.     

Incidence and risk factors of intraocular pressure elevation after triamcinolone acetonide administration for macular disorders

PURPOSE: We investigated the incidence and risk factors of intraocular pressure (IOP) elevation following triamcinolone administration for macular disorders. METHODS: Intravitreal or posterior sub-Tenon's injections of triamcinolone acetonide were conducted on 119 eyes with macular disorders. The change in IOP was followed for all cases. Risk factors for IOP elevation were examined regarding causal disease, history of vitrectomy, methods of injection, frequency of injection, refractive power, and age. RESULT: The difference between the mean baseline IOP (13.0 +/- 2.9 mmHg) and the maximum mean IOP (21.5 +/- 9.8 mmHg) was statistically significant (p< 0.0001). The final mean IOP was 15.1 +/- 3.6 mmHg. Forty-one eyes (34.5%) had IOP elevation over 21 mmHg during the follow-up. Fifty-nine eyes (49.6%) showed pressure elevation of over 5 mmHg. One eye (1%) required trabeculotomy to control the IOP. Risk factors for the IOP elevation included younger age, high myopia, no history of vitrectomy, and multiple injections. CONCLUSION: Careful follow-up of the IOP is required after triamcinolone acetonide injections.     

Factors associated with success in first-time trabeculectomy for patients at low risk of failure with chronic open-angle glaucoma

PURPOSE: To examine the relationships between study factors and trabeculectomy outcome in a representative sample of United Kingdom ophthalmology surgeons and patients. DESIGN: Cross-sectional observational study by questionnaire. PARTICIPANTS: All ophthalmic surgeons performing trabeculectomy in the National Health Service were invited to select their 4 most recent consecutive trabeculectomy cases satisfying study eligibility criteria before June 1996. Three hundred eighty-two surgeons supplied baseline data for 1450 patients and 1-year follow-up data for 1240 (85.3%) patients. All patients had undergone first-time trabeculectomy for chronic open-angle glaucoma. METHODS: Data were collected by self-administered questionnaires at baseline and 6 and 12 months postoperatively. Univariate analysis of the relationships between study factors and success was performed by chi-square test (categorical variables) and Student's t or Mann-Whitney U tests (continuous variables). Multiple logistic regression modeling of explanatory variables significant at a P value of 相似文献   

Comparison of travoprost 0.0015% and 0.004% with timolol 0.5% in patients with elevated intraocular pressure: a 6-month, masked, multicenter trial

OBJECTIVE: To compare the safety and intraocular pressure (IOP)-lowering efficacy of once-daily travoprost (0.0015% and 0.004%) to twice-daily timolol 0.5%. DESIGN: Prospective, 6-month, randomized, controlled, multicenter, double-masked, phase III study. PARTICIPANTS: Six hundred five patients with open-angle glaucoma or ocular hypertension. METHODS: Patients with an 8 AM IOP between 24 to 36 mmHg in at least one eye (the same eye) at two eligibility visits received either travoprost 0.0015%, travoprost 0.004% (dosed every day), or timolol 0.5% (dosed twice daily). MAIN OUTCOME MEASURES: Mean IOP at 8 AM, 10 AM, and 4 PM in the patient's eye with the higher baseline IOP. RESULTS: The mean IOP was significantly lower for both concentrations of travoprost compared with timolol. Travoprost was statistically superior to timolol at 9 of 13 visits, with differences in IOP reductions ranging from 0.9 to 1.8 mmHg (0.0015%) and 10 of 13 visits with differences in IOP reductions from 0.9 to 2.4 mmHg (0.004%). Mean IOP changes from baseline ranged from -6.0 to -7.5 mmHg (0.0015%), -6.5 to -8.0 mmHg (0.004%), and -5.2 to -7.0 mmHg for timolol. Hyperemia was experienced at rates of 29.2% (59 of 202) for travoprost 0.0015%, 42.8% (86 of 201) for travoprost 0.004%, and 8.9% (18 of 202) for timolol. Iris pigmentation changes were observed in 1.0% (2 of 200) of patients receiving travoprost 0.004% with no changes noted in the travoprost 0.0015% group or the timolol group. A decrease in pulse and systolic blood pressure was observed in the timolol group. There were no other clinically relevant or statistically significant changes from baseline in ocular signs or laboratory values, and no serious, related, unexpected adverse events were reported for any group. CONCLUSIONS: Travoprost (0.0015% and 0.004%), dosed once daily in the evening, is statistically superior or equal to timolol 0.5% dosed twice daily at all treatment visits during this 6-month study. IOP reductions of up to 2.0 mmHg greater than timolol were found in the travoprost 0.004% pooled data group. Travoprost is safe and well tolerated in patients with open-angle glaucoma or ocular hypertension.     

A 3-month randomized controlled trial of bimatoprost (LUMIGAN) versus combined timolol and dorzolamide (Cosopt) in patients with glaucoma or ocular hypertension

PURPOSE: To compare the efficacy and safety of topical bimatoprost (LUMIGAN; Allergan, Inc., Irvine, CA) once daily with that of topical combined timolol and dorzolamide (Cosopt; Merck and Co, Inc., Whitehouse Station, NJ) twice daily. DESIGN: Prospective, randomized, double-masked, multicenter clinical trial. PARTICIPANTS: One hundred seventy-seven patients with a diagnosis of glaucoma or ocular hypertension and inadequate control of intraocular pressure (IOP) after at least 2 weeks of topical timolol maleate 0.5% monotherapy. METHODS: Patients were randomized to receive bimatoprost 0.03% once daily (n = 90) or combined timolol 0.5% and dorzolamide 2% twice daily (n = 87) over a 3-month period. MAIN OUTCOME MEASURES: Intraocular pressure, the primary end point, was measured at 8 AM and 10 AM at baseline, week 1, and months 1, 2, and 3, and also at 4 PM and 8 PM at baseline and month 3. RESULTS: Bimatoprost provided significantly greater IOP lowering compared with combined timolol and dorzolamide. At the 8 AM measurements, bimatoprost lowered mean IOP 6.8 mmHg to 7.6 mmHg from baseline, whereas combined timolol and dorzolamide lowered mean IOP 4.4 to 5.0 mmHg from baseline (P<0.001). At the last follow-up, patients had better diurnal IOP control with bimatoprost than combined timolol and dorzolamide. At 8 AM at the 3-month visit, the percentages of patients achieving IOPs of 相似文献   

The effect on diurnal intraocular pressure of the fixed combination of latanoprost 0.005% and timolol 0.5% in patients with ocular hypertension

PURPOSE: To measure the effect on intraocular pressure (IOP) after single-dose administration of the fixed combination of latanoprost 0.005% and timolol 0.5%. METHODS: A randomized, double-masked placebo-controlled parallel-group study was carried out. Twenty patients with ocular hypertension received the fixed combination of latanoprost+timolol, while 10 received placebo eyedrops. On baseline day no eyedrops were given, but IOP was measured repeatedly between 8.00 a.m. and 8.00 p.m. On Day 7 the eyedrops were given at 8.00 a.m., and IOP measured as on baseline day. On Day 8 and Day 9, IOP was again measured at 8.00 a.m. RESULTS: There was no difference in IOP in the placebo group. In the latanoprost+timolol group maximal IOP reduction (12.4+/-2.8 mmHg; mean+/-standard deviation) occurred 6.4 hours after drug administration (5.2--7.7 hours; 95% confidence interval [CI]). The mean IOP reduction after 24 hours was 9.8 mmHg (7.4--12.2 mmHg; 95% CI; p<0.001), and after 48 hours 5.7 mmHg (3.4--8.1 mmHg; 95% CI; p<0.001). CONCLUSIONS: The fixed combination of latanoprost+timolol statistically significantly reduced IOP after single-dose administration. The maximal effect was noted after about 6 hours, and the IOP reduction was still pronounced after 48 hours.     

曲伏前列素与布林佐胺治疗开角型青光眼或高眼压症的临床研究

目的:研究曲伏前列素与布林佐胺联合治疗原发性开角型青光眼(primary open angle glaucoma,POAG)、高眼压症(ocular hypertension,OHT)及抗青光眼术后高眼压的降眼压疗效及安全性。方法:将48例52眼POAG,OHT,抗青光眼术后高眼压的患者纳入为期2mo的前瞻性、单向性、开放性研究。经药物洗脱期测量眼压基线值。用药后2,4,8,12wk测量眼压、视力、视野,观察眼部症状、体征及全身副作用。计算12wk时眼压≤17mmHg患者百分比。结果:患者基线眼压28.08±2.50mmHg,4次随访眼压(17.12±1.42,16.71±1.55,16.13±1.52,16.12±1.49)mmHg,眼压下降均值10.35mmHg,最大下降率45%。用药后眼压与基线眼压比较差值有非常显著意义(P<0.01),用药12wk时,眼压≤17mmHg的患者占64%。常见的不良反应是结膜充血,偶见轻微烧灼感,轻度味觉异常等,对角膜、泪膜、视力、视野、血压、心率均未影响。结论:曲伏前列素与布林佐胺联合应用降眼压的效果明显,安全性好。联合用药,眼压≤17mmHg患者所占百分比显著。     

制作慢性高眼压动物模型的一种新方法--水下电凝巩膜表面静脉法

目的研究慢性高眼压动物模型的制作方法.方法选择20只健康Wistar大鼠,雌雄不限,随机分为高眼压组(10只)和sham对照(假手术)组(10只).高眼压组采用电凝鼠巩膜表面至少三组静脉及角膜缘周围血管,减少房水静脉回流升高眼压,而sham对照组只剪开球结膜,未进行巩膜表面静脉以及角膜缘周围血管电凝.分别于术后1,2,3,4及8wk测大鼠双眼压,结果进行统计学分析.结果高眼压组右眼术后眼压明显升高.术后1wk眼压(30.35±4.98)mmHg(1kPa=7.5mmHg),术后1～8wk间眼压基本稳定.术后各时间点高眼压组右眼眼压与术前、左眼及sham对照组右、左眼间比较,差异有统计学意义(P＜0.001).结论采用电凝鼠巩膜表面至少三组静脉及角膜缘周围血管,减少房水静脉回流能成功复制慢性高眼压动物模型.