[Glaucomatous visual field loss in eyes undergoing first trabeculectomy in Iceland]. / Sjónsviðsskerðing við fyrstu hjáveituaðgerð (trabeculectomiu) vegna gláku

INTRODUCTION: Glaucoma is a degenerative disease in the optic nerve with associated visual field defects (VFD). Trabeculectomy is the most common glaucoma surgery. Surgery is indicated if glaucomatous optic neuropathy progresses despite tolerated medical treatment or in patients with severe VFD. The purpose of this paper is to describe the severity of visual field damage in patients undergoing their first trabeculectomy in Iceland. METHODS: A retrospective review of medical records of all patients with open angle glaucoma that underwent first trabeculectomy at Landspítali University Hospital, from June 2013 to March 2016. Visual fields were examined by Octopus automated perimetry and the severity of glaucoma damage was staged according to the mean defect (MD). RESULTS: 86 eyes were included in the study, mean age 75 ± 11 years, 57% men. Patients used on average three IOP lowering medications. Mean MD at referral to surgery was 13.4 ± 7.7dB (min 0.8dB, max 26.2 dB), 21% had early glaucomatous damage (MD <6dB), 23% moderate (MD 6-12 dB) and 56% severe (MD > 12). CONCLUSION: VFD at referral to surgery varied from mild VFD to severe damage. Like clinical guidelines recommend, treatment seems to be individualized and the most common indication for surgery was increased VFD despite medical treatment. Mean MD at referral to surgery was high compared to other studies. Eyes with severe VFD had on average lower IOP and thinner cornea. This might indicate that great emphasis is placed on high IOP and perhaps too little emphasis on VFD and cornea thickness.

[Medical management of glaucoma and interaction between glaucoma and systemic medications].

INTRODUCTION: Glaucoma used to be the most common cause for blindness in Iceland. As the incidence of glaucoma increases with age, the patients often have numerous comorbidities and use various medications. It is important to keep in mind interactions and side effects of glaucoma medications when deciding systemic medical treatment for these patients to ensure their safety and comfort. The goal of the study was to gather information about drug use of patients with severe glaucoma. METHODS: A retrospective study where data were collected from 100 consecutive patients who underwent a trabeculectomy as first glaucoma surgery at Landspitali National University Hospital of Iceland during 2013-2017. All systemic and ophthalmic medications during 6 months before and after the surgery, medical diagnoses, age and gender of the patients were registered. RESULTS: Of all 100 patients, 87 used systemic medication, averaging 5.3 drugs/patient. Mean number of glaucoma medication used was 3.0. Mean age at surgery was 75 years and 53 were women. The most common systemic drug class was anti-hypertensives, used by 57 patients where beta-blockers were the most common, used by 30 patients. Zopiclone was the most common single drug, used by 29 patients. CONCLUSION: It is evident that patients with glaucoma take various drugs for systemic illness that can affect their glaucoma and have interactions with glaucoma drugs. It is urgent that healthcare providers keep this in mind when deciding on systemic treatment for patients with glaucoma, with regards to possible interactions with glaucoma drugs and the effect on patient's overall health.

[Endocarditis in Iceland 2000-2009, a national survey incidence, microbiology and prognosis]. / Hjartathelsbólga á íslandi 2000-2009 - nýgengi, orsakir og afdrif.

INTRODUCTION: The objective of this study was to analyze the incidence, clinical features, microbiology and prognosis of patients with infective endocarditis (IE) in Iceland, and to compare the results with a previous study made in Iceland 1976-85. MATERIAL AND METHODS: A retrospective study including all patients diagnosed with IE in Iceland 2000-2009. Information was obtained from medical records. RESULTS: A total of 88 cases (71% men, mean age 59 years) were diagnosed and the incidence of IE was calculated 2.97/100.000 person-years. The mitral valve was infected in 35 patients (40%), aortic in 27 (31%) and tricuspid in 9 (10%). In 19 cases a prosthetic valve was infected (22%), one early (<<60 days from procedure) and 18 late. Sixteen patients were intravenous drug users. The most common causative organisms were streptococcus (33%), staphylococcus (25%) and enterococcus (16%). Surgical intervention was performed in 16 cases (18%). One and five year survival was 77% and 57% respectively. CONCLUSION: The incidence of IE in Iceland is still low compared to other countries. The clinical profile of the disease has changed since 1976-85, patients with prosthetic heart valves and intravenous drug users were more prominent than before. The microbiological spectrum has not changed much, streptococcus is still the most common pathogen, contrary to what is seen in other industrial countries where S. aureus is more frequent. Death rate is lower than before and one year survival good compared to other reports.