Glaucoma Service, Prabha Eye Clinic and Research Centre, Bangalore, India.
HOD- Ophthalmology, Sundaram Medical Foundation, Chennai, India.
Indian J Ophthalmol. 2022 Jan;70(1):24-35. doi: 10.4103/ijo.IJO_1762_21.
Glaucoma is the second leading cause of blindness in India. Despite advances in diagnosing and managing glaucoma, there is a lack of India-specific clinical guidelines on glaucoma. Ophthalmologists often refer to the European Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines. A group of glaucoma experts was convened to review the recently released EGS guideline (fifth edition) and the APGS guideline and explore their relevance to the Indian context. This review provides the salient features of EGS and APGS guidelines and their utility in Indian scenario. Glaucoma diagnosis should be based on visual acuity and refractive errors, slit-lamp examination, gonioscopy, tonometry, visual field (VF) testing, and clinical assessment of optic nerve head, retinal nerve fiber layer (RNFL), and macula. The intraocular pressure target must be individualized to the eye and revised at every visit. Prostaglandin analogues are the most effective medications and are recommended as the first choice in open-angle glaucoma (OAG). In patients with cataract and primary angle-closure glaucoma (PACG), phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Trabeculectomy augmented with antifibrotic agents is recommended as the initial surgical treatment for OAG. Laser peripheral iridotomy and surgery in combination with medical treatment should be considered in high-risk individuals aged <50 years. In patients with phakic and PACG, phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Visual acuity, VF testing, clinical assessment of the optic disc and RNFL, and tonometry are strongly recommended for monitoring glaucoma progression.
青光眼是印度第二大致盲原因。尽管在诊断和治疗青光眼方面取得了进展，但印度缺乏专门针对青光眼的临床指南。眼科医生经常参考欧洲青光眼学会（EGS）和亚太青光眼学会（APGS）的指南。一组青光眼专家被召集来审查最近发布的 EGS 指南（第五版）和 APGS 指南，并探讨它们与印度情况的相关性。本综述介绍了 EGS 和 APGS 指南的显著特征及其在印度情况下的应用。青光眼的诊断应基于视力和屈光不正、裂隙灯检查、房角镜检查、眼压测量、视野（VF）测试以及视神经头、视网膜神经纤维层（RNFL）和黄斑的临床评估。眼压目标必须根据每只眼睛的情况进行个体化，并在每次就诊时进行修订。前列腺素类似物是最有效的药物，推荐作为开角型青光眼（OAG）的首选药物。对于白内障和原发性闭角型青光眼（PACG）患者，推荐单独行超声乳化术或联合超声乳化术和青光眼手术。建议在 OAG 初始手术治疗中，用抗纤维蛋白药物增强小梁切除术。对于<50 岁的高危人群，应考虑激光周边虹膜切开术和联合药物治疗的手术。对于有晶状体和 PACG 患者，推荐单独行超声乳化术或联合超声乳化术和青光眼手术。强烈建议监测青光眼进展时进行视力、VF 测试、视神经头和 RNFL 的临床评估以及眼压测量。
