terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

3.5.2 - LASER TRABECULOPLASTY 77-89 Indications: POAG, exfoliative and pigmentary glaucoma when IOP is not satisfactorily controlled with medications, where the latter are contraindicated, or where compliance is a problem, such as in the elderly. Should initial medical therapy fail to control the patient`s glaucoma, ALT could be offered for patients with heavily pigmented trabecular meshwork and for those patients who are infirm, elderly, or have a short life expectancy. Preoperative preparation: - prevention of IOP spikes: topical apraclonidine 1% and/or oral acetazolamide one hour prior to the procedure and immediately afterwards - topical anaesthesia Procedure: Argon laser (Green or Blue/Green) Diode laser Lenses: - Goldmann type gonioscopy lens - Ritch trabeculoplasty lens © - CGA © Lasag • Identify angle landmarks • Laser burns placed between the anterior pigmented trabecular meshwork and the non-pigmented trabecular meshwork ie mid to anterior third of the trabecular meshwork over 180 or 360 degrees. If necessary, repeat 2 weeks later over the other 180 degrees if only half circumference was initially treated. When electing to perform two sessions of 180 degrees, make sure not to repeat the treatment in the same quadrant. Laser parameters: Spot Size: 50 µm Exposure time: 0.1 seconds Power: 500-1200 mW according to the reaction on the trabecular meshwork Optimal reaction: transient blanching or small gas bubble formation Complications: Transient decrease in visual acuity due to gonioscopy contact fluid, inflammation, significant IOP elevation Transient iritis Early and transient IOP elevations Visual field loss as a consequence of IOP spikes Peripheral anterior synechiae, especially after posteriorly placed burns, or a narrow drainage angle Late IOP rise due to loss of effect (not infrequent after longer follow-up) Post-operative management: - Check the IOP during the first 1-6 hours. If this is not possible, treat with oral CAIs and α 2 agonists to prevent IOP spikes in susceptible patients. - Topical corticosteroids or non-steroidal anti-inflammatory agent TID or QID for 4-7 days. Close monitoring is suggested in the following cases: advanced glaucomatous optic nerve damage with severe field loss, one-eyed patients, high pre-laser IOP, exfoliation syndrome, previous laser trabeculoplasty Ch. 3 - 30 EGS
Results The outcomes of a number of randomized prospective clinical trials should be taken into account when considering a patient`s suitability for laser trabeculoplasty 78-84 . Large independent clinical trials have shown progressive loss of effect over time 85-87 . Alternative laser systems for laser trabeculoplasty: Those found effective in reducing IOP in glaucoma include trabeculoplasty with continuous wave lasers of red and infrared wavelengths 88 , and, recently, a large spot size, high power, low energy Q-switched, frequency doubled neodymium:YAG (532 nm) system 89 . 3.5.3 - LASER IRIDOPLASTY 76 Indication • To widen the angle approach by shrinking the peripheral iris using a thermal effect. • Plateau iris syndrome • In preparation for ALT when the angle approach is narrow, in order to better visualize the TM • Angle closure in nanophthalmos Preoperative preparation As for ALT Contraindications severe corneal edema or opacification flat anterior chamber synechial angle-closure Lenses Laser contact lenses Abraham lens Goldmann type lens, aiming through the central part, not the mirrors Laser parameters Contraction burns Spot Size: 300-500 mm Duration: 0.2-0.5 seconds Power: 200-400 mW Location: the aiming beam should be directed at the most peripheral portion of the iris Goal of treatment is contraction of the peripheral iris with flattening of the peripheral iris curvature. Ideal number of impacts: 20-50 applications over 360° leaving 2 beam diameters between each spot and avoiding visible radial vessels Complications: mild iritis corneal endothelial burns transient post-operative IOP elevation posterior synechiae of the pupil permanent pupil dilation Postoperative treatment: topical steroids for 4-7 days prevention of IOP spikes (see Ch. 3.6.2) Post-operative management Some as under 3.5.2 Ch. 3 - 31 EGS
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ISBN: 88-87434-13-1 Editrice DOGMA
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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
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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
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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 116 and 117: 3.5 - LASER SURGERY 3.5.1 - LASER I
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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