Risultati per: Scoperta possibile causa del glaucoma

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Introduction
Glaucoma is the leading cause of irreversible blindness in the world. The need to diagnose glaucoma early in its natural history before extensive sight loss occurs cannot be overemphasised. However, glaucoma is largely asymptomatic in the early stages of the disease making it complex to diagnose clinically and requires the support of technology. The objective of this scoping review is to determine the nature and extent of the evidence for use of portable devices in the diagnosis of glaucoma.

Methods
We will consider studies conducted in all healthcare settings using portable devices for the detection of all type of adult glaucoma. We will also include any systematic reviews or scoping reviews, which relate to this topic. Searches will be conducted in MEDLINE, Embase, CENTRAL on the Cochrane Library and Global Health databases, from their inception to the present. Reference lists from publications identified in the searches will also be reviewed. Two authors will independently screen titles and abstracts, followed by full-text screening to assess studies for inclusion. Any disagreements will be discussed and resolved with a third author. Tables accompanied by narrative descriptions will be employed to discuss results and show how it relates to review questions.

Ethics and dissemination
Ethical approval is not required in this review. Only published and publicly accessible data will be used. We will publish our findings in an open-access, peer-reviewed journal and develop an accessible summary of results and recommendations.

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Objective
To compare the efficacy and safety of different anti-vascular endothelial growth factor (VEGF) agents combined with different delivery methods for neovascular glaucoma (NVG).

Design
Systematic review and Bayesian network meta-analysis (NMA).

Data sources
PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, ISRCTN and Chinese databases including the China National Knowledge Infrastructure, China Science Periodical Database (Wanfang Database), VIP Journal Integration Platform and China Biology Medicine Database were searched from inception to 5 September 2022.

Eligibility criteria
We included randomised controlled trials (RCTs) that investigated the treatment of NVG using different anti-VEGF agents combined with various methods of drug administration, without any language limitations. All patients included underwent panretinal laser photocoagulation and there were no restrictions on prior glaucoma surgery.

Data extraction and synthesis
Two independent reviewers extracted data and assessed the risk of bias. Random-effect Bayesian NMA was conducted to compare the efficacy and safety and rank priority of anti-VEGF regimens. The source of heterogeneity and the related factors affecting the stability of the results were also explored. CINeMA (Confidence in Network Meta-Analysis) was used to assess the certainty of evidence.

Results
Our analysis included 17 RCTs involving a total of 1311 eyes from 1228 patients. We examined five different treatment regimens, which used three different anti-VEGF drugs. The following treatments showed a significant decrease in intraocular pressure (IOP) compared with the control group at 1 month after glaucoma surgery: simultaneous intravitreal and intracameral injection of conbercept (ICCIVC) (mean difference (MD)=–11.56, 95% credible interval (CrI) –20.8 to –2.24), intravitreal injection of conbercept (MD=–8.88, 95% CrI –13.93 to –3.78), intravitreal injection of ranibizumab (MD=–7.62, 95% CrI –10.91 to –4.33) and intravitreal injection of bevacizumab IVB) (MD=–5.51, 95% CrI –10.79 to –0.35). The surface under the cumulative ranking curve (SUCRA) analysis indicated that ICCIVC (82.0%) may be the most effective regimen in reducing IOP. In terms of safety, there were no statistically significant differences among the interventions. According to the SUCRA analysis, ICCIVC (68.0%) was considered the safest choice with the fewest complications. Subgroup and meta-regression analyses showed that mean age was the main source of heterogeneity. Sensitivity analysis demonstrated the robustness of the study results.

Conclusion
ICCIVC was more effective and safer than other anti-VEGF regimens for NVG. Simultaneous intravitreal and intracameral injection was found to be the best route of administration, and conbercept was found to be the superior drug selection when compared with ranibizumab and bevacizumab.

PROSPERO registration number
CRD42022309676.

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‘Hanno picchiato dei ragazzini, le scuse non mi interessano’

Il ricordo di Filippo Anelli, presidente della Fnomceo. Tre milioni italiani rinunciano a cure a causa del Ssn che arranca

Objectives
Glaucoma care demand in UK hospitals has exploded in recent years. This has resulted in a push to community (shared, virtual, etc) care models to reduce the burden on hospital systems and on patients. The study aimed to ascertain patient’s experiences around various aspects of their care delivered in community clinics.

Design
Observational study.

Setting
Glaucoma Community Clinic, Cambridge, UK.

Participants
Ninety-six consecutive patients (M:F 47:49, mean age 70±12 years), recruited from July to September 2022.

Outcome measures
Patients completed a modified glaucoma patient-reported outcome and experience measure (POEM) regarding their clinic experience and perspective on their diagnosis, treatment and fear of blindness. Patient’s thoughts of feeling safe under the community clinical team were gathered. Patient demographics including age, gender, postcodes and education history were used to find their corresponding Lower-Layer Super Output Areas and socioeconomic status.

Results
Patients had positive perceptions of their clinic experience. Ninety-six per cent of patients reported that their experience of attending the community clinic was comfortable, and 93% (n=92) felt the experience was the same as expected from the hospital. Feeling safe under the clinician team produced a mean Visual Analogue Scale (VAS) score of 90 (SD 15) and feeling care was organised produced a mean VAS score of 87 (SD 17). Age, gender, disease characteristics and socioeconomic status had no influence on perceived experience. Patients aged

Ministero della Salute, assistiti dal servizi 129.259 nel 2022

This JAMA Patient Page describes the eye disease glaucoma, risk factors, symptoms, diagnosis, and treatment.

Introduction
Angle-closure is responsible for half of all glaucoma blindness globally. Patients with suspected glaucoma require assessment of the drainage angle by an experienced clinician. The goal of this study is to evaluate the diagnostic performance and cost-effectiveness of two non-contact tests, anterior segment OCT (Optical Coherence Tomography) (AS-OCT) and limbal anterior chamber depth for patients referred to hospital with suspected angle closure compared with gonioscopy by ophthalmologist.

Methods and analysis
Study design: prospective, multicentre, cross-sectional diagnostic accuracy study. Inclusion criteria: adults referred from community optometry to hospital with suspected angle closure. Primary outcome: Sensitivity and specificity. Secondary outcomes: Positive/negative likelihood ratios, concordance, cost-effectiveness, proportion of patients requiring subsequent clinical assessment by ophthalmologist. Sample size: 600 individuals who have been referred with suspected angle closure from primary care (community optometry). We will have a 95% probability of detecting the true sensitivity of either test to within ±3.5% based on a sensitivity of 90%. The study would also have a 95% probability of detecting the true specificity of either test to within ±5%, assuming a specificity of 75%.

Ethics and dissemination
Ethical Review Board approval was obtained. REC reference: 22/LO/0885. Our findings will be disseminated to those involved in eye care services. We will have a knowledge exchange event at the end of the study, published via the Health Technology Assessment web page and in specialist journals. The results will be presented at professional conferences and directly to patients via patient group meetings and the Glaucoma UK charity.

Trial registration number
ISRCTN15115867.

Objectives
To investigate the associations of alcohol consumption and smoking with the development of perimetric glaucoma in patients with suspected glaucoma.

Design
A retrospective cohort study of patients suspected to have glaucoma enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES).

Setting
Three tertiary glaucoma centres in the USA.

Participants
825 eyes of 610 patients with glaucoma suspect eyes with normal visual fields (VF) at baseline were followed over an average of 9 years from the DIGS and ADAGES studies.

Outcome measures
Development of glaucoma was defined as occurrence of three consecutive abnormal VF tests during follow-up. Univariable and multivariable Cox regression models were used to investigate lifestyle-related factors associated with development of VF loss over time.

Results
VF tests were abnormal three times in a row in 235 (28.5%) eyes. Alcohol consumption was associated with a higher risk of developing glaucoma (HR 1.57, 95% CI 1.03 to 2.38, p=0.037). In men, the risk of developing glaucoma in alcohol drinkers (HR 1.92, 95% CI 1.00 to 3.68, p=0.048) was greater than non-alcohol drinkers. In individuals of African descent, the risk of developing glaucoma in alcohol drinkers (HR 1.79, 95% CI 1.02 to 3.15, p=0.043) was greater than non-alcohol drinkers. Age was a modifier of the relationship between smoking and glaucomatous VF defects (p=0.048). The risk of developing glaucoma in smokers (HR 1.73, 95% CI 1.10 to 2.72, p=0.019) was greater than never smokers after adjustment for confounding factors in older patients (age >61 years).

Conclusion
Alcohol consumption was associated with an increased risk of developing glaucoma, particularly in men and individuals of African descent. The risk of developing glaucoma among smokers suspected of having glaucoma was influenced by age, with older individuals having a higher risk than younger people.

Trial registration number
NCT00221897 and NCT00221923.

Il 6 ottobre presso la Scuola Agraria del Parco di Monza incontro sulle esperienze di lavoro inclusivo