Shared care for glaucoma.
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Allied Health Personnel↗
Biomedical subjects
R Hitchings
Publications and source records attributed to R Hitchings.
Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma.
PURPOSE: This randomly allocated prospective clinical study was designed to assess the relative efficacy of laser trabeculoplasty, medical therapy, and trabeculectomy used as the primary treatment in open-angle glaucoma, with particular regard to the level of intraocular pressure control and the amount of visual field decay. No patient had received any antiglaucoma treatment before entry into the trial. METHODS: One hundred sixty-eight patients were entered into the trial and randomly allocated into one of the three treatment groups--laser, medicine, or surgery. Follow-up was for a minimum of 5 years. The patients were monitored in the standard way, including intraocular pressure estimations and visual field tests (initially using the Friedmann analyzer and later including Humphrey automated perimetry). RESULTS: Despite similar initial composition of the three treatment groups, primary surgery resulted in the lowest mean intraocular pressures. The perimeter Friedmann visual fields were shown to have deteriorated in patients in the medicine-treated group and to a lesser extent in patients in the laser-treated group, but not in patients in the surgery-treated group. Multivariate linear regression analysis showed that the difference in field changes between laser and surgical treatments could be explained entirely by the difference between the intraocular pressure values at 6 months between the two groups. The same was not true for the medicine-treated group. CONCLUSION: Primary trabeculectomy appears to have the desired effect in preserving visual function in patients with high-tension glaucoma. This may be related to laser treatment might be expected to have the same effect.
Aged↗
Diurnal intraocular pressure variation in low-tension glaucoma.
A retrospective analysis of diurnal variation in intraocular pressure (IOP) in 101 untreated low-tension glaucoma (LTG) patients was carried out to ascertain the role of IOP as a causative factor in the aetiology of optic nerve damage in LTG. The diagnosis of LTG was made only after IOP monitoring as an inpatient, which involved 2 hourly consecutive measurements by Goldmann applanation tonometry from 08:00 to 22:00 hours inclusive. The highest IOP during the diurnal curve was 17.4 mmHg (SD 3.00) at 10:00 and the lowest value was 15.0 mmHg (SD 2.7) at 22:00. Seventy-seven per cent of patients had a peak IOP value recorded between 08:00 and 12:00 hours inclusive. The mean peak IOP was 18.3 mmHg (SD 2.6) and the mean trough was 13.1 mmHg (SD 2.2). Thus the mean diurnal range in IOP of 5.2 mmHg (SD 2.2) was similar to that reported by other workers in normals. Neither the diurnal pattern nor the range of IOP values seen in this study supports the view that abnormal IOP levels are a significant risk factor in the pathogenesis of optic nerve damage in all patients with LTG.
Adult↗
Racial differences in the results of glaucoma filtration surgery: are racial differences in the conjunctival cell profile important?
Conjunctival biopsies were obtained at the time of filtration surgery from 90 patients with glaucoma; 45 of these patients were black and 45 white. Forty nine of the patients (25 black, 24 white) had undergone a primary trabeculectomy. Comparisons between black and white patients were made with respect to the results of surgery and differences in conjunctival cell profile. In agreement with many authors, trabeculectomy was found to be less successful in black patients (67% compared with 80%), although this finding was not statistically significant by survival analysis. In addition, conjunctiva from black patients was found to contain a greater number of macrophages and a smaller number of both mast cells and goblet cells in comparison with white patients. There was a tendency for conjunctiva from black patients to contain more fibroblasts. Conjunctiva obtained from the patients whose filtration surgery subsequently failed was found to contain more fibroblasts, macrophages, and basal epithelial pale cells. A greater number of conjunctival macrophages and possibly fibroblasts in black patients may partially explain the tendency for a lower success rate of filtration surgery in this group of patients.
Adult↗
Evaluation of the Humphrey FASTPAC threshold program in glaucoma.
The makers of the Humphrey perimeter have developed a rapid thresholding program, FASTPAC, to address the problems of fatigue and poor test performance associated with prolonged perimetry. The performance of FASTPAC was compared with the standard threshold program of the Humphrey visual field analyser (program 24-2) in 44 glaucoma patients. FASTPAC reduced the mean test time by 35% (from 12.6 to 8.2 minutes), owing to a reduction in the number of stimulus presentations. FASTPAC underestimated the mean deviation (MD) (Wilcoxon, p = 0.007) and corrected pattern standard deviation (CPSD) (Wilcoxon, p = 0.005). The sum of the differences between FASTPAC and the standard program was -1.19 (SD 2.37) dB for MD and 0.97 (2.14) dB for CPSD. The measured difference between the two methods was independent of the value of either MD or CPSD, indicating that the measurement error was just as likely to occur with either early or advanced visual field loss. No difference was noted in short term fluctuation or in the reliability indices of test performance. These results indicate that FASTPAC, while considerably faster, is not as accurate as the standard threshold program at measuring retinal sensitivity in glaucoma. This inaccuracy may be offset in practical terms by greater patient acceptability and by increasing the number of patients capable of performing reliable threshold perimetry because of the reduction in duration of the FASTPAC program.
Aged↗
Adverse effects of topical antiglaucomatous medications on the conjunctiva.
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Administration, Topical↗
Hypertropia following insertion of inferiorly sited double-plate Molteno tubes.
The use of double-plate Molteno tubes is well established in the management of intractable glaucoma, particularly in eyes that may have had previous surgical procedures, often involving the superior conjunctiva with subsequent subconjunctival scarring. As it is frequently the case that the area of least scarring is inferiorly, we have sited the tubes there but have found that, although this usually provides good control of intraocular pressure, successful drainage of aqueous has been associated with the development of hypertropia due to upward displacement of the globe by fluid encapsulated around the plates. We report a retrospective study of 16 eyes undergoing inferiorly sited double-plate Molteno tubes, in which 9 eyes developed significant hypertropia at a mean time after insertion of 3.5 months. Mean degree of hypertropia was 9.8 prism dioptres. The management of this complication is discussed.
Adolescent↗
Morbidity following prolonged postoperative hypotony after trabeculectomy.
The postoperative course of a series of 54 patients that had undergone primary trabeculectomy for open-angle glaucoma is reviewed. Almost one third of the eyes had prolonged postoperative hypotony with an intraocular pressure less than 8mm Hg for more than 2 weeks. The possible significance of prolonged hypotony and choroidal effusions is discussed in relation to the final intraocular pressure and the effect on visual acuity.
Choroid↗
Control of chronic simple glaucoma with primary medical, surgical and laser treatment.
This prospective clinical study comparing laser trabeculoplasty, medical therapy and surgery as the primary therapy for 168 patients with untreated chronic simple glaucoma, showed that the surgical group resulted in the lowest mean intraocular pressures, and was most effective in controlling the diurnal swing of intraocular pressures. Laser trabeculoplasty resulted in a lesser degree of pressure reduction but these patients were more frequently subject to high pressure spikes. Medical therapy was the least effective in lowering pressure.
Clinical Trials as Topic↗
Primary therapy for chronic simple glaucoma the role of argon laser trabeculoplasty.
This report compares the preliminary findings in three groups of patients suffering from chronic simple glaucoma who were treated with either laser, medicine or surgery, as the primary therapeutic procedure, and followed for a minimum period of six months. It is suggested that there is a place for primary treatment by surgical trabeculectomy in those patients who present with advanced chronic simple glaucoma, while argon laser trabeculoplasty would appear to have a very definite role in the primary treatment of all other patients with this disease.
Aged↗
The developing bleb: effect of topical antiprostaglandins on the outcome of glaucoma fistulising surgery.
A prospective trial of topical antiprostaglandins versus placebo in the treatment of postoperative fistulising surgery followed up for 12 months is described. It is concluded that antiprostaglandins have little place in the management of these cases. A photographic record of evolution of the fistulising bleb is described, together with a scoring system devised for the evolution of the successful fistulising bleb. A comparison is made between appearance and function of the fistulising bleb based on the use of the water drinking test and tonography together with intraocular pressure as tests of bleb function. It is concluded that the appearance of the established bleb alone is an insufficient guide to function, particularly if further surgery--for example, cataract extraction--is required.
Adult↗
Effect of antiprostaglandins on glaucoma filtration surgery.
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Adult↗
Low-dose combined guanethedine 1% and adrenaline 0.5% in the treatment of chronic simple glaucoma: a prospective study.
This paper reports on the results of a prospective double-blind crossover study, comparing adrenaline 1% with adrenaline 0.5% combined with guanethedine 1% over an 8-week period with each formulation. The guanethedine/adrenaline formulation was found to be the more effective hypotensive agent of the two. This study confirms the potentiating effect of adding guanethedine to adrenaline, and suggests that this combination would be a useful alternative treatment when adrenaline 1% or adrenaline 0.25% with guanethedine 1% is insufficient.
Aged↗
Compressed air injury of the eye.
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Accidents, Occupational↗