Current opinion in ophthalmology
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Curr Opin Ophthalmol · Apr 2004
Review Randomized Controlled Trial Clinical TrialFactors for progression and glaucoma treatment: the Early Manifest Glaucoma Trial.
This review summarizes factors for progression in the Early Manifest Glaucoma Trial (EMGT), including the effect of treatment. EMGT randomized patients with early glaucoma either to argon laser trabeculoplasty plus betaxolol (n = 129) or to no immediate treatment (n = 126) and followed them every 3 months. ⋯ EMGT treatment reduced progression risk in half, demonstrating the value of IOP lowering in early glaucoma. Age and indicators of disease severity also predicted progression.
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This review of the more recent literature and testing strategies in patients with chiasmal syndromes focuses on the clinical evaluation and management of these patients. Visual loss is often the initial manifestation of disorders involving the optic chiasm. Hemianopic defects and preferential involvement of the temporal visual field are the earliest and most common visual deficits. Progression of the lesion may cause compression of adjacent structures, including the optic nerves and cavernous sinuses, and may result in more profound visual loss, ocular motor deficits, and hypopituitarism. ⋯ Most chiasmal syndromes can be categorized as intrinsic (thickening of the chiasm itself) or extrinsic (compression of the chiasm from an adjacent structure). Magnetic resonance imaging is the best mode of neuroimaging for most chiasmal lesions and may also provide clues to the etiology of an isolated chiasmal syndrome.
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Health care economic analyses are becoming increasingly important as health care costs consume an increasing proportion of the gross domestic product (GDP). Among the different forms of health care economic analysis are (1) cost-minimization analysis, (2) cost-benefit analysis, (3) cost-effectiveness analysis, and (4) cost-utility analysis. Cost-utility analysis is the most sophisticated because it incorporates the value (improvement in quality of life and length of life) conferred by an intervention for the resources expended. The different types of analyses of importance to the clinician are addressed herein.
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Sarcoidosis commonly involves the eye, causing uveitis, the lacrimal gland, and the cranial nerves, including the optic nerve itself. Several microorganism types have recently been located in sarcoid granulomas, suggesting an infective cause in predisposed individuals. ⋯ New ophthalmic manifestations have been described, suggesting a wider role for sarcoidosis in intraocular inflammation, and indocyanine green angiography has clarified choroidal involvement. Immunosuppressive and anticytokine treatments can be effective in severe systemic sarcoidosis and should be considered in sight-threatening disease.
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Curr Opin Ophthalmol · Dec 2000
ReviewSystemic disorders associated with retinal vascular occlusion.
Occlusions of the retinal arterial and venous circulations are common causes of severe visual decline and can affect all age groups. Acute retinal arterial obstruction is often associated with critical cerebrovascular and cardiovascular disease that may require systemic treatment. ⋯ Additional metabolic and hematologic abnormalities have been identified in patients with retinal occlusive disease. The authors review recent advances in the study of systemic conditions associated with retinal vascular occlusions and offer guidelines for appropriate medical evaluation of patients with retinal occlusive disease.