Advanced glaucoma: management pearls.
Advanced glaucoma: management pearls.
复制标题
DOI：
10.4103/0974-9233.110610
复制
发表时间：
2013-04-01
影响因子：
0.6
通讯作者：
Damji, Karim F
中科院分区：
文献类型：
--
作者：
Gessesse, Girum W;Damji, Karim F
很大一部分青光眼患者就诊较晚，特别是在发展中国家，不幸的是，他们已处于疾病晚期。他们面临着失去剩余视力的迫在眉睫的危险，并且还可能受到各种社会经济和健康挑战的困扰。从患者的角度来看，遇到此类患者的典型特征是焦虑/恐惧，有时甚至是绝望。医生也可能觉得他们在控制患者的疾病方面处于困难的境地。在处理此类病例时，我们建议采取整体、个性化的方法，考虑到每位患者的“生物心理社会精神”（BPSS）概况。 BPSS 模型考虑了相关的眼部和全身生物学（青光眼机制、眼压水平 [IOP]、进展率、预期寿命、总体健康状况等因素）、心理因素（例如恐惧、抑郁）、社会经济因素以及精神/文化价值观和信仰，然后才能与患者及其护理伙伴一起决定治疗目标应该是什么以及如何最好地实现这些目标。晚期青光眼的治疗非常有效，应告知患者及其护理伙伴，积极将眼压降低至十几岁甚至个位数是保护剩余视力的最佳机会。在大多数情况下，通过小梁切除术（包括抗代谢药物），以及在某些情况下通过药物和/或激光治疗，可以安全有效地实现这一目标。还应考虑视力康复和社会心理支持，以优化剩余视力，酌情用希望代替恐惧，从而提高整体生活质量。
A significant proportion of glaucoma patients present late, particularly in the developing world, and unfortunately, in an advanced stage of the disease. They are at imminent danger of losing remaining vision, and may also be afflicted with various socioeconomic and health challenges. The encounter with such a patient is typically characterized by anxiety/fear and sometimes hopelessness from the patient's perspective. The physician may also feel that they are in a difficult position managing the patient's disease. When dealing with such cases, we suggest a holistic, individualized approach taking into account the 'biopsychosociospiritual' (BPSS) profile of each patient. The BPSS model takes into account relevant ocular as well as systemic biology (factors such as the mechanism of glaucoma, level of intraocular pressure [IOP], rate of progression, life expectancy, general health), psychological considerations (e.g., fear, depression), socio-economic factors and spiritual/cultural values and beliefs before being able to decide with the patient and their care partner(s) what treatment goals should be and how they can best be approached. Treatment for advanced glaucoma can be highly effective, and patients and their care partners should be informed that aggressive IOP lowering to the low teens or even single digits offers the best chance of protecting remaining vision. This can be achieved safely and effectively in most cases with trabeculectomy (including an antimetabolite), and in some cases with medical and/or laser therapy. Vision rehabilitation and psychosocial support should also be considered in order to optimize remaining vision, replace fear with hope as appropriate, and thus improve the overall quality of life.