| Objective To understand the blinding rate and related epidemiological characteristics of glaucoma among the general population and glaucoma inpatients in Chongqing,China.To investigate the effects of glaucoma surgery on the blinding rate and its clinical effects.The study consists of three parts.Part Ⅰ General population based epidemiological survey of glaucomaMethods An epidemiological survey was used to investigate glaucoma among people aged 40 years or older in Rongchang district and Qijiang District of Chongqing.To understand the blinding rate,prevalence,and related epidemiological characteristics of glaucoma among the general population in Chongqing,China.Results1.Glaucoma was diagnosed in 70 of 4073 individuals,with a prevalence of 1.72%,and PACG was the predominant type,accounting for 41.4%.Blinding occurred in 47.14% of the70 patients with glaucoma,with SG showing the highest blinding rate of 85.71% among the three types of glaucoma.2.There were no significant differences in the prevalence of PACG and POAG between genders.The overall prevalence of glaucoma was 2.5% in the group aged over 70 years,which was significantly higher than that in other age groups.3.Glaucoma detection rate was low at on-site screening.When IOP and C/D factors were considered together,glaucoma detection rate was 55.88%.4.Obesity and family history of glaucoma were risk factors for glaucoma patients.Conclusions1.The blinding rate of population-based glaucoma patients was 47.14%,with secondary glaucoma having the highest blinding rate of 85.71%.2.The prevalence of glaucoma among people aged 40 years or older in Chongqing was1.72%.The proportion of PACG decreased compared with previous reports,and the proportion of POAG increased.It suggests that we should strengthen early screening,early diagnosis,and early treatment of glaucoma in general population.3.The diagnosis of glaucoma is difficult on-site screening.Morphological examination using the optic nerve cup to disc ratio in the fundus is important to confirm the disease.Part Ⅱ Clinical patient-based blinding rate and epidemiology of glaucomaMethods The case data of glaucoma patients hospitalized in Southwest Hospital of Chongqing between 2010 and 2019 were retrospectively analyzed.The blinding rate and epidemiological characteristics were analyzed.Results1.A total of 5794 patients were included,of whom 1921 were blinded.The overall blinding rate was 33.15% and the blinding rate of patients older than 40 years was 32.96%.The highest blinding rate was 43.99% in SG and 25.09%,24.07% in PACG and POAG,respectively.2.The constituent ratio of PACG to POAG was 2.11:1.Overall,the percentage of SG showed a decreasing trend and the percentage of PACG showed an increasing trend during the last decade,while the constituent ratios of POAG and CG were almost maintained.3.The main affected population in PACG was women over 60 years old,accounting for45.95%.The proportion of males younger than 60 years was the highest among POAG patients,accounting for 39.83%.Among SG patients,males under the age of 60 years accounted for the highest percentage at 50.27%.Conclusions1.Among hospitalized patients with glaucoma,the blinding rate was 32.96% in patients older than 40 years.The highest blinding rate was 43.99% in SG,25.09% in PACG,24.07% in POAG.This is consistent with the results of population-based epidemiological investigations.2.SG was the predominant type followed by PACG and POAG among patients hospitalized with glaucoma in our hospital over the last decade.The percentage of SG showed a decreasing trend,and the main type of SG was glaucoma secondary to ocular trauma,indicating that preventing ocular trauma is an important factor for reducing secondary glaucoma.3.Patients with glaucoma in the general population have a high rate of blinding because the diagnosis and treatment are not timely.In hospitalized patients,after active intervention,the blinding rate decreased,indicating that prevention and treatment measures aimed at early diagnosis and early treatment of glaucoma are important.Part Ⅲ Blinding rate of glaucoma patients after surgical intervention and evaluation of surgical outcomesMethods The clinical data of patients who were diagnosed with glaucoma and underwent primary trabeculectomy in Southwest Hospital of Chongqing between January 2016 and December 2018 were retrospectively reviewed to evaluate the blinding rate and surgical effects.Results1.A total of 325 eyes of 261 patients were included,116 males(44.4%)and 145 females(55.6%).PACG was the predominant type,accounting for 64.6%.Of 325 eyes,86 were blind preoperatively,and the blinding rate was 26.46%.At last follow-up,the blinding rate decreased to 12%.2.The survival curve analysis of K-M showed that the complete success rate was 77.8%,66.8%,and 47.2% at 1,2,and 3 years of follow-up,respectively,while the qualified success rate was 92.0%,88.5%,and 77.7%,respectively.There was no significant difference in the cumulative success rate of surgery between the two glaucoma types.3.PACG patients were divided into trabeculectomy group and trabeculectomy combined with cataract surgery group.Complete success rates were 76.7%,67.1%,58.3% in the trabeculectomy group and 81.7%,63.9%,36.5% in the combined group.The qualified success rate was 93.3%,88.4%,80.6% in the trabeculectomy group and 91.7%,83.3%,72.9% in the combined group.There was no significant difference in the success rate of the two surgical modalities for the treatment of PACG.4.Cox regression analysis showed that hypertensive disease,early postoperative encapsulated bleb,and more preoperative use of IOP lowering medications were risk factors for surgical failure.Conclusions1.This is the first time to report the blind rate and surgical outcomes of trabeculectomy in glaucoma patients from Chongqing,China.Based on the criterion of 6 ≤IOP≤ 21 mm Hg,the complete and qualified success rates at 3 years follow-up were 47.2%,77.7%,respectively,consistent with previous similar studies in Chinese populations.2.There was no significant difference in surgical outcomes between PACG and POAG.For patients with PACG,there was no significant difference in surgical outcomes between trabeculectomy alone and trabeculectomy combined with cataract surgery.3.The population-based blinding rage of glaucoma is high.The blinding rate decreases after clinical treatment,and decreases even further after surgical intervention in patients with glaucoma.Promotion of early diagnosis,early treatment,and appropriate surgical procedures are the main measures to prevent the blinding of glaucoma. |
PDF Full Text Request