ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Small-incision cataract surgery widens the scope of combined cataract and glaucoma surgery.Phacoemulsification is gaining in importance, although extracapsular extraction techniques are still commonly used. Trabeculectomy remains the standard filtration operation combined with cataract surgery.There are currently a number of areas of contention in combined trabeculectomy surgery, including the use of shared or separate incisions,the use of antimetabolites,and the type of intraocular implant.Other adjunctive procedures sucha as trabeculotomy and endocyclophotocoagulation are also discussed in the context of combined surgery.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Latanoprost is a new prostaglandin F2αanalogue specifically developed for the treatment of glaucoma. Latanoprost is a selective FP receptor agonist, with a primary mode of action of increased uveoscleral outflow of aqueous humor. A dose of 50 (μg/mL (0.005%) once daily has been found optimal in clinical trials. Latanoprost reduces the nocturnal intraocular pressure in addition to the diurnal, and has been shown to be additive to other glaucoma medication. In long-term phase III clinical trials, latanoprost 0.005% once daily has been proven to be at least as effective as timolol 0.5% twice a day. The main side effect of latanoprost is increased iridial pigmentation, which is relatively frequent in patients with mixed color of the iris. This unique side effect is based on the ability of prostaglandins to stimulate melanin formation in melanocytes. The advantages of latanoprost compared with other glaucoma medication comprise different mode of action, good intraocular pressure-reducing effect, once-daily dosing, and absence of systemic side effects. The long-term consequences of increased iridial pigmentation need to be further studied.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although great progress has been made in defining the spectrum of diseases known asglaucoma,its pathogenesis is still poorly understood. One common element seems to be the rise of intraocular pressure (IOP) beyond physiologic limits. The lowering of the existing IOP is accomplished either pharmacologically or surgically by decreasing the production of aqueous humor or by increasing aqueous humor outflow facility. Quite a number of pharmacologic agents are available to decrease IOP through distinctly different mechanisms. Since these drugs have their own mechanisms of action, some are used in combination in attempts to reduce the IOP to acceptable levels that will stabilize the optic nerve head excavation or the visual fields. In most patients with glaucoma β-blockers are the treatment of initial choice. However, in almost 50% of these individuals therapy with β-blockers alone does not reduce IOP adequately. Therefore, there is a need for new classes of topical IOP-lowering agents that can be used alone or in a combination with β-blockers. This review summarizes the possible perspectives of some of the antiglaucomatous drugs that have been introduced in 1995 as well as those still under clinical investigation.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The wound healing response is the single most important determinant of the final intraocular pressure after glaucoma surgery. The use of antiscarring agents, particularly the antimetabolites 5-fluorouracil and mitomycin C, have revolutionized glaucoma surgery over the past decade. This subject has become more important with the realization that simply lowering the intraocular pressure to below 21 mm Hg is inadequate, and that optimal lowering of the intraocular pressure should be achieved in all patients undergoing surgery for glaucoma. However, the antimetabolites still have many potential problems and side effects, some of which are potentially sightthreatening. This review concentrates on the recent publications in this field that have determined the current “state of the art,” with a view toward optimizing results and minimizing side effects for our patients with glaucoma in this exciting and challenging area of progress.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Retinal nerve fiber layer (RNFL) examination is a useful tool in the diagnosis and follow-up of glaucoma. Because the clinical techniques to date have been subjective, there is a definitive need to develop instruments that are capable of making accurate and reproducible measurements of the RNFL. Introduction of new quantitative methods, such as confocal scanning laser ophthalmoscopy and optical coherence tomography raises high expectations in clinical practice. In the Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, CA) the measurement technique is based on the assumption that the RNFL has birefringent properties. The change in the polarization state, called retardation, can be quantified by determining the phase shift between polarization of light returning from the eye with the known state of polarization of the illuminating laser beam. Theretardationshows a typical double-hump pattern of the RNFL thickness around the optic disk. After elimination of artifacts produced by the anterior segments of the eye, theretardationis related linearly to histopathologic thickness measurements of the RNFL in monkey and human eyes. Prior to large-scale implementation of this technique into clinical practice, however, several questions need to be answered.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The role of the villain in high-pressure glaucoma is played by ocular hypertension. Alterations of lamina cribosa, other mechanical alterations, and a possible loss of optic nerve head capillaries are all accountable, and from a therapeutic standpoint most clinicians readily perceive that lowering ocular pressure is the single most important management goal and are satisfied with such results. Yet, when confronted with normal intraocular pressure, other perturbing factors or at least other accomplices must be studied; in this case, an ischemic origin becomes the primary suspect, potentially engendering therapeutic consequences of a different nature.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This paper addresses the many forms of treatment for glaucoma. We studied particularly the topical drops and oral medications that are most frequently prescribed by ophthalmologists, specifically examining the reasons for the side effects experienced by certain patients taking topical drops and oral medications. Some of the side effects and interactions are discussed, and the importance of proper procedure for application of topical eye drops is stressed. Finally, we emphasize that proper drug usage is critical to the well being of the patient.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Early visual loss in glaucoma may not be detected with conventional perimetry because this technique uses simple spots of light that are perceived by any type of ganglion cells. Visual tests for central or peripheral vision have been designed to more specifically address subsets of cells that are impaired in the early phases of the disease. The rationale for use of these tests and their current clinical evaluation are reviewed in this paper. Many tests assessing different visual pathways give abnormal results in patients with suspected glaucoma and ocular hypertensive patients, favoring the hypothesis that multiple pathomechanisms are involved in the onset of glaucoma.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Short-wavelength automated perimetry (SWAP) uses a bright yellow background and a large blue stimulus to isolate and measure the sensitivity of short-wavelength-sensitive mechanisms throughout the central 30° visual field. After more than 8 years of cross-sectional and longitudinal studies of patients with early glaucoma, ocular hypertensive patients, and agematched control subjects, SWAP has been shown to be a sensitive indicator of early damage and progression of loss in glaucoma. It is now available as an optional visual test procedure for routine clinical use on the most widely distributed automated perimeter. Recent investigations have been directed toward refinement and standardization of the technique, as well as toward the influence of other clinical factors (ocular media opacities, macular pigment, statistical interpretation, and related issues) on SWAP. This paper provides a brief overview of current research on SWAP as a clinical diagnostic test procedure.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID