Costs of medical and surgical treatment of glaucoma.

PURPOSE: To compare county costs of medical and surgical glaucoma treatment. METHODS: Medical records of 470 patients who underwent trabeculectomies in 1992 were scrutinized for a period of 3 years before and 3 years after surgery (including the year of surgery). Treatment costs were based on DRG prices, and drug consumption costs on the "defined daily dose" (DDD). RESULTS: The costs rose steadily during the 3 years before surgery on account of more frequent visits and examinations and increased drug consumption. Mean total cost in the preoperative period was 13,355 SEK and that in the corresponding postoperative period, including surgery, was 23,684 SEK. The number of visits post-surgery was only slightly reduced, but there was a marked decrease in medication. However, the cost of the drugs was not correspondingly lower. Thirty percent of the patients later underwent cataract extraction. CONCLUSION: From a strictly economic point of view glaucoma surgery is not profitable within a 3-year postoperative period.

Consumption of glaucoma medication.

During recent decades consumption of antiglaucoma drugs has shown a steady increase in the Nordic countries. The cost increase can partly be explained by the use of newer, more expensive drugs. The increase in daily doses, however, is relatively much larger than the corresponding ageing of the population. There are large national and regional differences. Measured in daily defined doses (DDD) the consumption of glaucoma medication is almost three times as high in Sweden as in Denmark. Within all the Nordic countries there exists up to more than two-fold regional differences between high- and low-consuming counties. The new classes of IOP-lowering drugs have been very quickly adopted. Statistical data indicate that adding new drugs is more common than switching to a new therapy.

Blindness in glaucoma patients.

In order to determine the risk for bilateral blindness from glaucoma and to which extent other diseases are responsible for the disability, the registers of low vision clinics were surveyed. All registered patients still alive in 1991 with the diagnosis of glaucoma were included. Eighteen hundred and ninety-five patients fulfilled these criteria. Blindness was defined as bilateral visual acuity < or = 0.1. The majority of the patients (68%) had a visual acuity better than 0.1. The remaining 590 patients had a visual acuity < or = 0.1. In this latter group glaucoma was the reason for the low visual acuity in 20%, glaucoma in combination with other eye diseases in 35% and other eye diseases in 44%. Macular degeneration and cataracts were the main causes of the low vision in the latter group. The prevalence of glaucoma blindness in the Stockholm region was found to be 0.007% for glaucoma and 0.020% for glaucoma in combination with other eye diseases.

Cataract development in adult bone marrow transplant recipients.

In a prospective study, adult patients treated with bone marrow transplantation were examined with respect to cataract development. There were 99 patients with a survival of at least one year. Ten of them had aplastic anemia and the rest had various hematological malignancies. Mean follow-up time was 3.9 years (range 1-10). All in the hematological malignancies group but none in the aplastic anemia group, were conditioned with irradiation. Cytostatic drugs were administered in all cases. Depending on the type of disease and its reaction to bone marrow transplantation, steroid treatment was sometimes indicated. Cataract did not occur in any of the 10 patients treated for aplastic anemia, whereas all patients with hematological malignancies had developed cataract after 4 years' observation. Most patients in the hematological malignancies group already showed lens opacifications after 2 years. Cataract surgery on the first eye was performed in 39 cases, a median of 3.7 years after bone marrow transplantation. Cataract development was clearly correlated to radiation. No relationship was found to other conditioning treatments, although a synergistic effect is possible.

Iodixanol in femoral arteriography. A randomized, double-blind, phase III, parallel study with iodixanol 270 mg I/ml and iohexol 300 mg I/ml.

Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events.

Intraocular pressure after extracapsular cataract extraction with implantation of posterior chamber lenses.

To determine factors which influence postoperative intraocular pressure (IOP) we retrospectively reviewed changes in pressure during the first postoperative week in 633 consecutive eyes undergoing extracapsular cataract extraction (ECCE) with implantation of a posterior chamber lens. The material was restricted to four surgeons and two types of lenses. IOP was measured preoperatively, one day and one week after surgery. Glaucomatous eyes (n = 113) as well as exfoliative non-glaucomatous eyes (n = 79) had a higher mean IOP (27.8 and 26.1 mmHg) the first postoperative day compared to 'simple' cataract eyes (20.1 mmHg). After one week mean IOP in glaucomatous eyes still remained elevated while exfoliative non-glaucomatous eyes had regained preoperative values. Mean IOP on the first postoperative day (18.8, 24.5, 23.1 and 13.2 mmHg respectively) was also dependent on surgeon. To some extent the IOP could be correlated to tightness of suturing as estimated by keratometry. Only one surgeon had significant difference between irrigated and non-irrigated visco-elastic substance. Postoperative pressure was not only dependent on the status of the patient's eye, but factors for the individual surgeons seemed to be as important.

Cataract development and outcome of surgery in bone marrow transplanted children.

Cataract development in bone marrow transplanted (BMT) patients was studied prospectively. There were 61 children, transplanted before the age of 18 years, who survived more than 1 year after transplantation. Patients transplanted for leukaemia (n = 43) were conditioned before BMT with cyclophosphamide (Cy) and total body irradiation (TBI). Patients with severe aplastic anaemia (SAA) (n = 9) only received Cy. None of the patients with SAA developed cataracts. All children with leukaemia, who were followed for at least 3 years (n = 37), developed lens posterior subcapsular cataracts (PSC). Cataract extraction was performed in 28 eyes, on average 5.1 years (range 3-9 years) after BMT. Postoperative corrected visual acuity was similar to that before BMT. The majority of cases needed laser capsulotomy within 2 years after cataract extraction. TBI seems to be the main cause for the high incidence of cataract after BMT. A relationship to steroid administration could not be proved, but a contributory effect is not excluded.

Pressure control in glaucoma patients after cataract surgery with intraocular lens.

In a retrospective study 97 patients with glaucoma and 16 with ocular hypertension were examined with regard to intraocular pressure (IOP) after extracapsular cataract extraction with implantation of a posterior chamber lens. During the follow-up 39 cases dropped out but 63 glaucoma patients and 11 patients with ocular hypertension were followed for three years. Compared to preoperative IOP 59% of the patients treated previously with Argon laser trabeculoplasty (ALT) had an IOP rise of > 10 mm Hg the day after surgery. The corresponding proportion among medically treated patients was 34% (P = 0.01). A pressure rise of > 10 mm Hg was less frequent among patients treated with one drug than among those treated with two or three (P = 0.05). During follow-up eight patients had a pressure rise which could not be controlled medically and they had to undergo additional ALT or surgery. All eight had been treated with ALT or with glaucoma filtering surgery prior to the cataract operation. After three years observation of 63 of the glaucoma patients, 63% were having less medical therapy than preoperatively, 30% an equal amount and 7% more; 49% (31 of 63) were still without any therapy. In the group of patients who preoperatively were only treated medically, no definite increase in therapy was needed in the long term.

The development of cataract in children as a late side-effect of bone marrow transplantation.

Children with hematological malignancies (n = 33), severe aplastic anemia (SAA, n = 7) and other non-malignant diseases (n = 4) were followed for cataract development after bone marrow transplantation (BMT). The children with hematological malignancies were subjected to total body irradiation (TBI), 10 Gy, in one session with no shielding of the eyes as part of their conditioning regimen before BMT. The children with SAA or other non-malignant diseases received either no irradiation before BMT or a reduced dose, 8 Gy, with shielding of their eyes. After 3 years all patients who had undergone BMT for hematological malignancies had developed lens opacification. No patients in the other groups, without leukemia, showed any sign of cataract development. There was no relationship between steroid treatment for graft-versus-host disease and cataract development. No relation to age of onset of treatment or to the sex of the patient and cataract formation was seen. It seems evident from the present study that TBI given in one session was the main cause of cataract development after BMT.

Factors influencing the formation of posterior capsular opacities after extracapsular cataract extraction with posterior chamber lens implant.

This study was designed to determine whether different factors could influence the formation of posterior capsular opacities. The study group comprised 271 patients who had undergone an extracapsular cataract extraction with implantation of a posterior chamber lens either with or without laser ridge. Between 12 and 25 months after surgery, a statistically significant difference was found with a lower rate of secondary cataract in the laser ridge group, but with respect to advanced secondary cataract, i.e. eyes which needed YAG capsulotomy, no statistically significant difference was found (P-value 0.99). No association was found between age or sex of patients, different surgeons or complications during or after surgery and the risk of getting a secondary cataract.

Comparison of iopromide versus iohexol in aortobifemoral arteriography. A Swedish multi-center study of 446 patients.

A double-blind randomized, clinical trial was conducted in 9 hospitals comparing the use of non-ionic contrast media (CM) iopromide 300 (Ultravist) and iohexol 300 (Omnipaque) during peripheral arteriography in a total of 446 patients. After premedication with morphine-scopolamine each patient was given two consecutive injections of 50 ml CM at a rate of 12 ml/s above the aortic bifurcation. Both CM were well tolerated. There were no differences between the two substances as far as general tolerance, pulse rate, blood pressure, sensation of heat or pain after CM injection were concerned.

Multiple-dose, dose-response relationship for the topical carbonic anhydrase inhibitor MK-927.

The multiple-dose, dose-response curve of MK-927 was studied in a five-center, double-masked, randomized, placebo-controlled, parallel study of 2%, 1%, and 0.5% MK-927 in 76 patients with bilateral primary open angle glaucoma or ocular hypertension and intraocular pressure greater than 24 mm Hg following washout of ocular hypotensive medications. Patients received doses at 8 AM and 8 PM for 14 days, and parallel 12-hour intraocular pressure curves were performed prestudy and on day 14, with 4-hour curves on days 1 and 4. There was a significant dose-response relationship, with 0.5% MK-927 twice daily being a minimal-effect dose. Both 1% and 2% MK-927 were active through 12 hours postdose, and peak mean percent decrease in pressure at 2 hours postdose was 18.6% and 20.6%, respectively.

Dry eye syndrome in long-term follow-up of bone marrow transplanted patients.

Out of 77 bone marrow transplanted patients surviving at least 1 year, 43% developed ocular manifestations of the sicca syndrome. This reaction was more frequent in patients with graft-versus-host disease (GVHD). Kerato-conjunctivitis sicca (KCS) developed in 28 patients (54%) who had survived acute GVHD but in only five cases (20%) of those without that complication. The incidence of dry eyes was 62% in the chronic GVHD group. All seven sicca cases in patients with aplastic anemia were seen in patients with chronic GVHD, while 10 out of 26 patients with hematological malignancies and without chronic GVHD had KCS. Two of these had not experienced any acute GVHD. Irradiation may contribute to the development of KCS, since all patients with hematological malignancies, in contrast to aplastic anemia patients, had undergone total body irradiation.

[Retinal changes--degeneration or side effect caused by etretinate (Tigason) therapy?]. / Retinale Veränderungen--Degeneration oder Nebenwirkung durch Etretinat (Tigason)-Therapie?

Case report of retinal changes in a patient treated with etretinate (Tigason). The possibility of drug-induced retinopathy is discussed.

Aqueous humor concentration of metoprolol after oral administration.

The concentration of the beta-adrenergic blocking agent metoprolol was determined in the blood plasma and aqueous humor after oral administration of the compound. One group (10 cases) was receiving their prescribed continuous therapy and the other group (20 cases) received a single dose of metoprolol. The concentration of metoprolol was usually higher in aqueous than in plasma after continuous administration. This differs significantly from administration of a single dose where the concentration of metoprolol was higher in plasma. The result indicates an ocular accumulation of the drug in chronic systemic treatment.