Glaucoma, the leading cause of blindness in Japan, is classified into open-angle and angle closure glaucoma. There is no curative treatment for primary open-angle glaucoma and, therefore, disease management is the basis of treatment. In contrast, if primary angle closure glaucoma (PACG) is not treated appropriately, the prognosis of visual function is poor, and the risk of blindness is three to five times higher than that of open-angle glaucoma. PACG is a particularly important subtype of glaucoma that must be diagnosed correctly and treated appropriately. Therefore, medical practitioners have a heavy responsibility in this disease. Primary angle closure disease (PACD) is a new term that encompasses the precursor lesions of PACG. Recently, findings from large-scale epidemiological studies of glaucoma in Japan and overseas as well as advances in anterior segment imaging have led to a better understanding of PACD pathogenesis and a significant change in the disease concept. Moreover, the classification and treatment strategies have been updated with the introduction of new terminology. This article outlines the current state of PACD treatment.

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This study aimed to elucidate the practice of nurses at Hospital A. We qualitatively analyzed 13 case reports published over the past 5 years. The nurses perceived refusal of treatment and care as distressing. They actively sought treatment options and methods to minimize discomfort and attempted to alleviate symptoms. In cases where recovery was a prolonged process, they encouraged a mindset of viewing the patient's situation positively as a process of achieving goals, emphasizing not lowering the level of self-care. The nurses accepted the honest feelings and continued to find out what they could do for the patients and their families. Additionally, they focused on the patient's characteristics and background, (deciding between what is important in life and continuing treatment) and provided individualized nursing care. It was suggested that these characteristics are highly versatile, as nursing care is tailored to each patient's uniqueness in Hospital A.

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[Background] The age at which dialysis is initiated in Japan is increasing, and there is a growing demand for peritoneal dialysis, particularly as a form of terminal care (referred to as " Last Peritoneal Dialysis [PD]). At our hospital, 14 cases of PD were initiated in 2022, including five cases of the Last PD. In this report, we discuss two of the five cases that we found particularly informative. Case 1 was a 73-year-old man with liver cirrhosis. After pancreatoduodenectomy, he had persistent ascites drainage (3 – 5 L/day), and his renal function worsened. We introduced PD because hemodialysis (HD) could not be performed due to frequent hypotension. The PD drainage volume, including the ascites, stabilized at 1 –2 L/day, and the patient was discharged. Case 2 was a 79 –year –old man presented with severe brain dysfunction. His wife and son took care of him. Due to end-stage renal failure, we placed a dialysis catheter and initiated HD. However, he could not maintain a lying down position during puncture and dialysis and required constant attendance by someone during dialysis. To avoid the self-extraction of the PD catheter, we created a PD catheter outlet in the left lateral abdomen and introduced a PD. [Conclusion] PD may help discharge patients who are terminally ill, have low Activities of Daily Living, or have difficulty with HD.

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