Sothornwit Nisa, Jenchitr Watanee, Pongprayoon Chalao
Department of Ophthalmology, Priest Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2008;91 Suppl 1:S111-8.
To assess the prevalence, mechanism and status of glaucoma, and to investigate the magnitude of visual impairment from glaucoma and its relating factors in Buddhist priest and novices.
Cross-sectional study of 190 patients treated in Glaucoma service, Priest hospital was performed. One hundred thirty seven patients with glaucoma and suspected glaucoma had comprehensive ophthalmic examination included interview on medical and ocular history, visual acuity, applanation tonometry, gonioscopy, optic disc, visual field evaluation, and retinal nerve fiber layer thickness measurement (Stratus Optical Coherence Tomography; Stratus OCT).
Glaucoma was diagnosed in 106 (77%) patients (181 eyes); 31 patients (23%) were glaucoma suspects. Open angle glaucoma (OAG) was found in 53 (50%) cases and classified into 36 (33%) primary open angle glaucoma and 17 (16%) normal tension glaucoma (NTG). Five (4.6%) patients had pseudoexfoliative glaucoma, 24 (23%) had primary angle-closure glaucoma (PACG), 10 (9.4%) had angle-closure glaucoma secondary to other causes (SACG), seven (6.6%) had secondary open angle glaucoma and seven (6.6%) were diagnosed of juvenile glaucoma. Among 31 glaucoma suspects, 18 cases were diagnosed based on disc appearance, eight based on intraocular pressure (IOP), two based on visual field and three cases had primary angle closure (PAC). The prevalence of glaucoma increased with age, with the highest prevalence (33%) in the age range 71 to 80 years. The Glaucoma service of Priest hospital diagnosed glaucoma in 53% of the priest. Rate of glaucoma was higher in priest from rural area than those from Bangkok and urban area. The mean baseline IOP was 26.5 +/- 14.7 mmHg. The mean treated IOP was 14.5 +/- 7.9 mmHg. The average mean deviation (MD) was -14.45 +/- 11.11. OCT showed average RNFL thickness of 70.8 +/- 35.6 microm. Glaucoma medications was received by 72% of the priest, 18% had laser treatment, and 22 % had glaucoma surgery. At diagnosis, two patients were blind according to WHO criteria, 29 (28%) patients were unilaterally blind, and seven (6.5%) had low vision. After treatment, 31 (29%) patients had unilateral blindness and none had bilateral blindness. The main associated diseases were hypertension, dyslipidemia, and diabetes. Transportation and financial condition were the major barriers in receiving eye care.
OAG comprised 50% of all glaucoma, 23% of PACG, and 16% of all subtypes of secondary glaucoma. The prevalence of glaucoma in priest rose significantly with age. In the treated glaucoma patients, 47% retained good visual outcome. Delayed diagnosis was a major factor for unsatisfactory outcome as 28% of patients had monocular blindness at diagnosis and 53% were previously unaware of their disease.
评估青光眼的患病率、发病机制及状况，调查僧侣和尼姑中青光眼所致视力损害的程度及其相关因素。
对在牧师医院青光眼科接受治疗的190例患者进行横断面研究。137例青光眼及疑似青光眼患者接受了全面的眼科检查，包括询问病史和眼部病史、视力、压平眼压测量、前房角镜检查、视盘、视野评估以及视网膜神经纤维层厚度测量（Stratus光学相干断层扫描；Stratus OCT）。
106例（77%）患者（181只眼）被诊断为青光眼；31例（23%）为青光眼疑似患者。53例（50%）为开角型青光眼（OAG），其中36例（33%）为原发性开角型青光眼，17例（16%）为正常眼压性青光眼（NTG）。5例（4.6%）患者为剥脱性青光眼，24例（23%）为原发性闭角型青光眼（PACG），10例（9.4%）为其他原因所致继发性闭角型青光眼（SACG），7例（6.6%）为继发性开角型青光眼，7例（6.6%）被诊断为青少年青光眼。在31例青光眼疑似患者中，18例根据视盘外观诊断，8例根据眼压（IOP）诊断，2例根据视野诊断，3例为原发性房角关闭（PAC）。青光眼患病率随年龄增长而升高，71至80岁年龄组患病率最高（33%）。牧师医院青光眼科诊断出53%的僧侣患有青光眼。农村地区僧侣的青光眼患病率高于曼谷和城市地区的僧侣。平均基线眼压为26.5±14.7 mmHg。平均治疗后眼压为14.5±7.9 mmHg。平均平均偏差（MD）为-14.45±11.11。OCT显示视网膜神经纤维层平均厚度为70.8±35.6微米。72%的僧侣接受了青光眼药物治疗，18%接受了激光治疗，22%接受了青光眼手术。诊断时，根据世界卫生组织标准，2例患者失明，29例（28%）患者单眼失明，7例（6.5%）患者视力低下。治疗后，31例（29%）患者单眼失明，无双眼失明患者。主要相关疾病为高血压、血脂异常和糖尿病。交通和经济状况是接受眼科护理的主要障碍。
OAG占所有青光眼的50%，PACG占23%，继发性青光眼所有亚型占16%。僧侣中青光眼患病率随年龄显著上升。在接受治疗的青光眼患者中，47%保持了良好的视力结果。诊断延迟是导致结果不理想的主要因素，因为28%的患者在诊断时单眼失明，53%的患者此前未意识到自己患病。
