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CILJ: U svrhu poboljšanja cjelokupnog upravljanja bolešću, poduzeta je sustavna sinteza postojećih znanja u području primarnog glaukoma otvorenog kuta (POAG). U ovom smo se istraživanju usredotočili na dokaze o postojanju čimbenika rizika za POAG, mimo povišenog intraokularnog tlaka (IOP), koji su potencijalno promjenjivi i/ili bi se mogli koristiti za pravovremenu identifikaciju ljudi s visokim rizikom za POAG; i na relativnu djelotvornost, podnošljivost i isplativost monokomponentnih topikalnih lijekova za snižavanje IOP u liječenju POAG, odnosno, okularne hipertenzije (OHT). METODE: Pregled sustavnih pregleda/meta-analiza primarnih prognostičkih studija i randomiziranih kontroliranih pokusa (RCT). Poduzeto je temeljito i osjetljivo pretraživanje Medline, Scopus i Cochrane baze podataka. Metodološka kvaliteta ocijenjena pomoću AMSTAR ljestvice a ukupna kvaliteta dokaza uporabom GRADE sustava. Za analizu podatka korišteni su ComprehensiveMetaAnalysis softaware verzija 2.2.064 2011. (Biostat Inc., New Jersey, USA) i SAS za Windows 9.2 (SAS Inc., Cary, NJ, USA) (makro za multiplu meta-regresiju). Zaključci se temelje na najboljim dostupnim dokazima. REZULTATI: Identificirano je 3606 zapisa uporabom dvije različite strategije pretraživanja; 25 studija zadovoljilo je kriterije za uključivanje u procjenu čimbenika rizika za POAG, a 16 studije za uključivanje u procjenu djelotvornosti i sigurnosti monokomponentnih topikalnih lijekova za snižavanje IOP u bolesnika s POAG/OHT. Samo šest sustavnih pregleda postiglo je "srednju" razinu kvalitete dokaza. Studije čimbenika rizika bile su, sveukupno, niske kvalitete, a pojedinačne studije pokazale su da nema povezanosti između pušenja i POAG, te da je u žena s dijabetesom blago povećan rizik za nastanak POAG. Dokazi " srednje kvalitete" pokazuju da prostaglandinske analoge (PGA) treba smatrati ekvivalentnima u pogledu djelovornosti, te da je latanoprost znatno bolje podnošljiv od travoprosta i bimatoprosta.. Ostali, „ne-PGA“, lijekovi, ne razlikuju se bitno jedni od drugih u pogledu djelotvornosti i sigurnosti. Timolol i brimonidin relevantno su manje djelotvorni od svih PGA. Isto vrijedi i za inhibitore karboanhidraze (CAI) u usporedbi s bimatoprostom. U pogledu podnošljivosti, timolol je superioran u odnosu na sve PGA i brimonidin, a CAI su superiorni bimatoprostu. ZAKLJUČAK: Identificirano je nekoliko potencijalnih čimbenika rizika za POAG osim IOP, međutim, s obzirom na nisku razinu dokaza, nisu mogući racionalni zaključci o doprinosu pojedinih čimbenika riziku za nastanak POAG. Dokazi srednje kvalitete pokazuju da kao monokomponentni topikalni tretman, latanoprost ima najbolji odnos djelotvornosti i sigurnosti., AIM: A systematic synthesis of the existing research evidence in the field of POAG is an appropriate methodological approach to achieve the aim of improved overall management of the disease. In the present study we focused on evidence on risk factors other than intraocular pressure (IOP) that are potentially modifiable and/or could be used for timely identification of people at high risk of POAG; and on relative efficacy, tolerability and cost-effectiveness profile of mono-compound topical IOP-lowering medications in treatment of POAG/OHT. METHODS: Systematic review of systematic reviews/meta-analysis of primary prognostic studies and randomized controlled trials (RCTs). A thorough and sensitive search of Medline, Scopus and Cochrane Databases was performed. Methodological quality of reviews and quality of evidence were assessed using the AMSTAR checklist and the GRADE system, respectively. Comprehensive Meta-Analysis softaware version 2.2.064 2011 ( Biostat Inc., Englewood, NJ, USA) and SAS for Windows 9.2 (SAS Institute Inc., Cary, NC, USA) (macros for multiple modifier meta-regression) were used for data analyses. Conclusions were based on the evaluation of the best available evidence. RESULTS: 3606 records were identified through two different search strategies; 25 studies met the inclusion criteria for evaluation of POAG risk factors and 16 for the evaluation of efficacy and safety of mono-compound topical IOP-lowering drugs. Only six reviews achieved an overall "moderate” quality of evidence. Reviews dealing with risk factors were of low quality in general, whereas individual studies indicated that there were no association between smoking and POAG and a weakly increased risk of POAG in diabetic women. “Moderate quality” reviews dealing with therapy indicate that prostaglandin analogues (PGAs) should be considered equivalent regarding efficacy, but latanoprost is relevantly better tolerated than bimatoprost or latanoprost. Non-PGA compounds do not relevantly differ between each other in either efficacy or safety. Timolol and brimonidine are relevantly less effective than all PGAs. The same is true for CAI vs. bimatoprost. Regarding tolerability, timolol is superior to all PGAs and brimonidine and CAI are superior to bimatoprost. Conclusion: Several potential risk factors for POAG apart from IOP were identified, however, no conclusion regarding their contribution could be drawn as the available information derives from low quality evidence. Available evidence of mono-compound IOP-lowering medications in treatment of POAG/OHT was identified. Moderate quality evidence indicates latanoprost as a mono-compound topical treatment with a most favourable trade-off between benefits and harms.

Glaucoma services are overwhelmed and struggling to accommodate current demand. Reducing the need for hospital based services would improve our ability to see those most at risk of vision loss, which could both reduce demand and improve patient outcomes. Digital technologies that provide opportunities for home monitoring of glaucoma progression have potential to contribute to solve these challenges and, potentially, improve glaucoma care. This article will review the literatures of well-established technologies that support home monitoring for glaucoma, specifically home tonometry (with rebound tonometry) and perimetry with Moorfields Motion Displacement Test and Melbourne Rapid Field.摘要: 青光眼的医疗服务已不堪重负但仍难满足当前需求, 减少对医院诊疗的需求有利于我们诊治哪些高风险的视力丧失患者, 这既能减少对医疗资源的需求又能改善患者预后。数字技术能在家中监测青光眼的进展, 并且有利于目前所面临的挑战, 以及提高青光眼的护理水平。本文通过检索文献, 对家庭监测青光眼的成熟技术作简要综述, 特别着重强调两种家用仪器: 家用眼压计 (回弹式眼压计) 以及利用Moorfields运动位移测试 (MMDT) 以及墨尔本快速视野检测仪 (MRF) 。.

Introduction: Eye injuries are common in sports and have the potential for major morbidity with sight threatening consequences. However, a small number of sports, such as soccer, rugby or hockey are responsible for most injuries. To our knowledge, hula hoop penetrating eye injury is not described in literature. In this report, we present a case of an unusual eye injury caused by a hula hoop. Case presentation: A 17-year-old female was admitted as an urgent penetrating right eye injury caused by a hula hoop. Penetrating wound covered 2/3 of the cornea and was associated with iris prolapses and incarceration; iridodialysis of more than half of the circumference, and traumatic cataract. Her best corrected visual acuity of the right eye was “hand motion”. The second corneal wound in parallel with the first one was noticed while she was being treated surgically under general anesthesia. Iris was repositioned, anterior chamber was formed with the viscoelastic and wounds were repaired using 10-0 nylon sutures. Iridopexy was performed using straight needle 10-0 prolene, while standard cataract surgery with phacoemulsification and IOL implantation were done. The postoperative recovery was uneventful beside elevated intraocular pressure (TOD = 24 mmHg) that was treated successfully by topical beta blockers. Six months later, her best corrected visual acuity was 0.6 stenopeic, with evident linear corneal opacification and traumatic mydriasis. Conclusions: Although seemingly impossible, hula hooping can be dangerous to the eyes if practiced in incommodious areas and close to other people.

Glaucoma subsumes a group of optic neuropathies with different causes and pathophysiological mechanisms that can permanently damage vision in the affected eye if left untreated (1,2). It is the leading cause of irreversible blindness worldwide (2-5). Depending on the mechanism of aqueous outflow impairment with respect to the anterior chamber angle configuration, glaucoma is classified as open or closed angle glaucoma. Open angle glaucoma (OAG) is by far more common (75%) and it is estimated that by the year 2020 it will affect 60 million people worldwide (2,4). Depending on the presence or absence of ocular or systemic disorders, OAG is classified as primary or secondary, with the primary form (POAG) prevailing. POAG is most commonly characterized by increased intraocular pressure (IOP), but IOP could also be consistently “normal”, ie, within ±2-3 standard deviations of an average “normal” value (6). Consequently, it is denoted as “high-tension” POAG (POAG-HTG) or as “normal-tension” POAG (POAG-NTG). In any case, it is a progressive chronic optic neuropathy in the absence of identifiable causes, where IOP and other unknown factors contribute to the loss of retinal ganglionic cells (RGCs) and their axons (7-9). When IOP is elevated but there is no detectable glaucomatous damage, the condition is called ocular hypertension (OHT) (8). Damage to the optical nerve is usually slow, and if treated, most patients retain useful vision for their entire lives. Therapeutic aim is to prevent impairment of vision by slowing down the apoptosis of RGCs. Different treatment modalities targeting factors that may play a role in POAG pathogenesis are being investigated (10-12) but for the time being, the only modality recommended by the professional guidelines is IOP-lowering treatment (7,8). Reduction of IOP prevents both conversion of OHT to POAG and progression of POAG (13-16), and can be achieved by medications, laser, or surgical therapy. Topical drug therapy is a standard initial intervention, whereas the latter two options are implemented mainly when conservative therapy is not effective, not tolerated, or not utilized by the patient (7-9). There are five major classes of IOP-lowering compounds, each comprising several individual drugs, and also a large number of their fixed combinations. They lower IOP by reducing aqueous production or/and by increasing aqueous outflow (7,17-20). According to the guidelines, IOP-lowering treatment should start with a mono-compound therapy and should aim to reduce IOP by 20%-30%. A rational first line mono-compound drug is the one installed as infrequently as possible for the therapeutic effect and with the fewest side-effects (7,8). If the first line medication is not effective or not tolerated it could be substituted, another drug may be added (unfixed combination), or a patient could be switched to a fixed combination of different compounds (8,17,18). A recent comprehensive evaluation (9,21) demonstrated a high level of evidence of efficacy in IOP reduction of various topical pharmacological treatments but with some uncertainty regarding their mutual relationship in this respect. The latter was in part due to inconsistent results of some studies and to the complexity of the setting (eg, different forms of OAG, treatment-naďve/previously unsuccessfully treated patients) and treatment modalities (mono-compounds, fixed/unfixed combinations) (9,21). We aimed to evaluate the existing evidence on relative efficacy and tolerability of mono-compound topical medications (recommended as initial treatment options) in POAG and OHT, the most common conditions requiring IOP-reducing therapy. Since by the year 2010 there were already 112 systematic reviews published on various aspects of glaucoma (22), of which at least 20 addressed medical treatments (23), we decided to perform an overview of systematic reviews, as they are generally considered a (potential) source of the highest level of evidence about therapeutic interventions.