The pathophysiology and treatment of glaucoma: a review.
The pathophysiology and treatment of glaucoma: a review.
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DOI：
10.1001/jama.2014.3192
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发表时间：
2014-05-14
期刊：
影响因子：
--
通讯作者：
Medeiros FA
中科院分区：
文献类型：
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作者：
Weinreb RN;Aung T;Medeiros FA
青光眼是世界范围内导致不可逆视力丧失的主要原因。因为它可能是无症状的，直到一个相对较晚的阶段，诊断往往被推迟。对疾病的病理生理学、诊断和治疗的一般了解可能有助于初级保健医生将高危患者转诊进行全面的眼科检查，并更积极地参与受这种情况影响的患者的护理。描述开角型青光眼和闭角型青光眼的病理生理学和治疗的现有证据。使用MEDLINE、科克伦图书馆和手稿参考文献对2000年1月至2013年9月期间以英文发表的开角型青光眼和闭角型青光眼主题的研究进行了文献检索。从筛选的4334篇摘要中，选择了210篇包含与初级保健医生相关的病理生理学和治疗信息的文章。视网膜神经节细胞瘤是一组进行性视神经病变，其特征在于视网膜神经节细胞变性并导致视神经乳头的变化。神经节细胞的丧失与眼内压水平有关，但其他因素也可能起作用。降低眼内压是治疗这种疾病的唯一有效方法。虽然治疗通常是开始与眼水肿下降，激光小梁成形术和手术也可以用来减缓疾病的进展。初级保健医生可以发挥重要作用，在青光眼的诊断，转介患者阳性家族史或可疑的视神经乳头的结果进行全面的眼科检查。他们可以通过加强药物依从性和持久性的重要性以及通过识别青光眼药物和手术的不良反应来改善治疗结果。
Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition. To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma. A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians. The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.