terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

3.5 - LASER SURGERY 3.5.1 - LASER IRIDOTOMY 76 Indication Clinically relevant pupillary block. Preoperative preparation - Pilocarpine 2% or 4% single instillation (unfolds the iris, reduces iris thickness, fascilitates perforation) - Prevention of IOP spikes Oral or intravenous acetazolamide Topical apraclonidine 1% One hour prior to the procedure and immediately afterwards, diminishes the frequency and magnitude of the acute postoperative IOP spikes and decreases bleeding due to the vasoconstrictor effect. Remember to check for known drug intolerance or other systemic contraindications. - Topical anaesthesia - Topical glycercerine, intravenous mannitol or oral hyperosmotic agents to be considered if the cornea is oedema tous Procedure A laser iridotomy contact lens is needed to keep the lids open, stabilize the eye, focus the laser beam and act as a heat sink, while providing additional magnification. Lenses - Abraham (+66 dioptres) - Wise (+103 dioptres) - CGI © LASAG CH Iridotomy site - superior quadrants of the iris covered by the upper lid (to prevent monocular diplopia) - avoid the 3 o`clock and 9 o`clock positions to lessen discomfort and reduce the risk of hitting the iris vessels - avoid visible vessels - as far peripherally as possible within the arcus senilis - choose a thin looking area or an iris crypt - electively superonasal to reduce the likelihood of a macular injury when using the Argon laser Laser parameters Nd:YAG Laser Iridotomy Power: 1-6 mJ Spot size: 50-70µm (constant for each laser model) Pulses per burst: 1-3 Focus the beam within the iris stroma rather than on the surface of the iris Lens capsule damage is possible above 2 mJ energy. Use the least amount of energy that is effective. With most lasers it is unlikely that more than 5 mJ per pulse will be needed. Ch. 3 - 28 EGS
Argon Laser Iridotomy When no Nd:YAG laser is available, the Argon laser may be used. There is no single group of laser parameters for all types of iris and for all surgeons The laser parameters need to be adjusted intraoperatively Preparatory stretch burns: Penetration burns: Spot size: 200-500 µm Spot Size: 50 µm Exposure time: 0.2-0.6 seconds Exposure time: 0.2 seconds Power: 200-600 mW Power: 800-1000 mW For pale blue or hazel irides, the following parameters are suggested: First step: to obtain a gas bubble Spot Size 50µm Exposure time 0.5 seconds Power: 1500 mW Second step: penetration through the gas bubble Spot Size 50µm Exposure time 0.05 seconds Power 1000 mW For thick, dark brown irides: Chipping technique Spot Size 50 µm Exposure time 0.02 seconds Power 1500-2500 mW The purpose of the procedure is to obtain a full thickness hole of sufficient diameter to resolve the pupillary block. Perforation is assumed when pigment, mixed with aqueous, flows into the anterior chamber. The iris usually falls back and the peripheral anterior chamber deepens. Patency must be confirmed by direct visualization of the lens through the iridotomy. Transillumination through the pupil or the iridotomy is not a reliable indicator of success. The optimal size of the iridotomy is 100 to 500 µm. Complications: Temporary blurring of vision Corneal epithelial and/or endothelial burns with Argon Intraoperative bleeding, usually controlled by a gentle pressure applied to the eye with the contact lens Transient elevation of the IOP Postoperative inflammation Posterior synechiae Late closure of the iridotomy Localized lens opacities Endothelial damage Rare complications include retinal damage, cystoid macular edema, sterile hypopion, malignant glaucoma. Post-operative management: Check the IOP after 1-3 hours, and again after 24-48 hours. When this is not possible, give prophylactic treatment to avoid IOP spikes Topical corticosteroids for 4-7 days Repeat gonioscopy Pupillary dilatation to break posterior synechiae Verify the patency of the peripheral iridotomy Ch. 3 - 29 EGS
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ISBN: 88-87434-13-1 Editrice DOGMA
Page 4 and 5:
ACKNOWLEDGEMENT This work was made
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2.2.5 - Primary Open-Angle Glaucoma
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Foreword These Definitions and Guid
Page 10 and 11:
INTRODUCTION The aim of the book is
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Since resources are limited worldwi
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II - RANDOMIZED CONTROLLED TRIALS F
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II.3 - COLLABORATIVE NORMAL TENSION
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No stratification for stage of dise
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II. 6. 3 - from CNTG 1. Therapy tha
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References 1) The Ocular Hypertensi
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I - QUESTIONS TO ASK TO YOUR GLAUCO
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III - ABNORMAL THRESHOLD VISUAL FIE
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V - GONIOSCOPIC OPEN ANGLES SOME DI
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VII - TREATMENT STEPLADDER JUVENILE
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IX - MONOTHERAPY (in alphabetic ord
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XI - MANAGEMENT ACUTE ANGLE CLOSURE
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XIII - ANTIMETABOLITES FOR WOUND MO
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CHAPTER 1 PATIENT EXAMINATION
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Other methods 22-25 : Air-puff tono
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References 1) Martin XD. Normal int
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1.2 - GONIOSCOPY Gonioscopy is a fu
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1 2 3 4 Fig. 1 Dynamic indentation
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The Spaeth classification Insertion
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References 1) Palmberg P. Gonioscop
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small - size mid - size large - siz
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Fig. 5 A) Cirumlinear vessel, B) Ba
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1.3.4.3 - OCT The Optical Coherence
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31) Carpineto P, Ciancaglini M, Zup
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central 24 or 30 central degrees re
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A retinal sensitivity value worse t
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HODAPP CLASSIFICATION 31 EARLY GLAU
Page 66 and 67: References 1) Bengtsson B, Heijl A,
Page 68 and 69: 1.5 - BLOOD FLOW 1.5.1 - VASCULAR F
Page 70 and 71: 28) Flammer J, Orgul S, Costa VP, O
Page 72 and 73: All forms of glaucoma should be cla
Page 74 and 75: 2.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
Page 76 and 77: 2.2.4 - PRIMARY OPEN-ANGLE GLAUCOMA
Page 78 and 79: 2.3 - SECONDARY OPEN-ANGLE GLAUCOMA
Page 80 and 81: 2.3.1.6 - Glaucoma due to intraocul
Page 82 and 83: 2.4 - PRIMARY ANGLE-CLOSURE Primary
Page 84 and 85: Systemic Risk factors for primary a
Page 86 and 87: OCCLUDABLE ANGLE: “Occludable”
Page 88 and 89: 2.5.3 - SECONDARY ANGLE-CLOSURE GLA
Page 90 and 91: CHAPTER 3 TREATMENT PRINCIPLES and
Page 92 and 93: Furthermore, blindness may occur de
Page 94 and 95: T A R G E T I O P Target IOP range
Page 96 and 97: Practical points for topical medica
Page 98 and 99: 3.3.1.1 - Category: ADRENERGIC AGON
Page 100 and 101: 3.3.1.2 - Category: ADRENERGIC ANTA
Page 102 and 103: 3.3.1.3 - Category: CARBONIC ANHYDR
Page 104 and 105: 3.3.1.4 - Category: PARASYMPATHOMIM
Page 106 and 107: 3.3.1.5 - Category: PROSTAGLANDIN D
Page 108 and 109: Drug interactions Precipitation occ
Page 110 and 111: COMBINATION THERAPY Starting* Addit
Page 112 and 113: 3.3.2.2 - Category: ADRENERGIC ANTA
Page 114 and 115: Pregnancy and nursing mothers Only
Page 118 and 119: 3.5.2 - LASER TRABECULOPLASTY 77-89
Page 120 and 121: 3.5.4 - CYCLOPHOTOCOAGULATION Indic
Page 122 and 123: Although medical therapy is still t
Page 124 and 125: 3.6.4 - COMPLEX CASES Complicated g
Page 126 and 127: Post-operative use Concentration: 0
Page 128 and 129: 25) Janz NK, Wren PA, Lichter PR, M
Page 130 and 131: (Rescula TM ) in patients with glau
Page 132 and 133: in white patients with open-angle g
Page 134 and 135: CHAPTER 4 TREATMENT GUIDELINES
Page 136 and 137: 4.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
Page 138 and 139: 4.2.7 - OCULAR HYPERTENSION (OH) Al
Page 140 and 141: 4.3.1.7 - Glaucoma associated with
Page 142 and 143: • Withdrawal of aqueous from vitr
Page 144 and 145: 4.5 - SECONDARY ANGLE-CLOSURE GLAUC
Page 146 and 147: 4.5.3 - SECONDARY ANGLE-CLOSURE GLA
Page 148 and 149: NOTES
Page 150 and 151: NOTES
Page 152: NOTES
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