NHMRC Glaucoma Guidelines - ANZGIG

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<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 11 – Patient journeys Figure 11.1: Open angle glaucoma pathway (see Table 8.2 for more information p100) Patient with suspected open angle closure History IOP Function Structure Risk assess Discuss risk benefi t. Reach consensus to undergo interviention. Provide literature to underpin understanding Diagnosis made and/or high-risk status Successful MONITOR Set target IOP Trial fi rst choice medication Medically unresponsive Adherence or administrative issues NO diagnosis and low-risk status MONITOR Trial second and/or third choice Successful MONITOR Long term Laser therapy Consider length of time before failure Successful MONITOR Ongoing Short term Filtering surgery with antimetabolite Successful MONITOR Rapid failure Rapid failure Aqueous shunts Cyclodestructive surgery Ongoing care and MONITORING National Health and Medical Research Council 161
<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 11 – Patient journeys Figure 11.2: Intermittent or chronic angle closure pathway Patient with suspected angle closure History IOP Function Structure Risk assess Discuss risk benefi t. Reach consensus to undergo interviention. Provide literature to underpin understanding Angle closure diagnosed Unilateral for chronic closure yAG Laser P.I. Peripheral Iridotomy (P.I.) Bilateral for acute or whenever access to medical services restricted Unilateral Surgical P.I. For acute closure where yAG P.I. not possible Ongoing monitoring for ALL patients Open MONITOR Consider patency of angle Closing rapidly and/or signfi cantly Consider cause Closing slowly and/or minimally Consider medication Synechial closure without posterior force Plateau iris or mild ciliary block NO cataract Plateau iris or mild ciliary block WITH cataract Ciliary block (severe) Drainage surgery trabeculectomy Iridoplasaty Lens extraction and IOL MONITOR Consider patency of angle Open MONITOR Closing Vitrectomy and anterior hyloidectomy Narrow post iridoplasty Ongoing monitoring for ALL patients 162 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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