terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

3.6.4 - COMPLEX CASES Complicated glaucoma cases such as those that have failed previous surgery, glaucoma secondary to uveitis, rubeosis, retinal surgery, congenital glaucomas, etc. require specialist treatment. In addition to trabeculectomy, other forms of therapy may be necessary such as glaucoma drainage devices, and ciliary body ablation with the diode laser (“cyclodiode”), free running YAG laser (“cyclo YAG”) or cryoprobe (“cyclocryotherapy”). (see Ch. 3.6.4, 3.7.5 and FC XII) 3.6.5 - DRAINAGE DEVICES The use of drainage devices such as those described by Molteno 134-139 , Krupin 140 , Baerveldt 141-144 , Ahmed 145-148 or Sbocket 149 is generally reserved for patients with risk factors for a poor result with trabeculectomy with antimetabolite. These factors include previous failed filtering surgery with antimetabolites, excessive conjunctival scarring due to previous surgery,with severe conjunctival or surface disease, active neovascular disease, paediatric aphakia, or where filtration surgery is going to be technically difficult 134-150 . A number of other devices aimed at replacing conventional filtering surgery for POAG are in different stages of development 151-152 . Ch. 3 - 36 EGS
3.7 - ANTIMETABOLITES IN GLAUCOMA FILTERING SURGERY See also Ch. 3.6.3.1 and FC XIII Antimetabolites are used to reduce scarring at the site of trabeculectomy 131,153-158 . Healing and scarring are the main determinant of the long term intraocular pressure control after trabeculectomy 169-163 . Aim: - to prevent postoperative conjunctival scarring with resultant failure of filtration - to reach a low target pressure Increaded risk for scarring: Neovascular glaucoma Previous failed glaucoma filtration surgery Previous cataract surgery (conjunctival incision) Aphakia (intracapsular surgery) Recent intraocular surgery (< 3 months) Inflammatory eye disease e.g. uveitis, ocular pemphigoid, Stevens-Johnson Syndrome, Afro-Caribbean / Hispanic race Young age Chronic topical medications Drugs used: 5-Fluorouracil: Dose: 5 mg. It is available in 25 and 50 mg/ml concentrations. 50 mg/ml now by far the most commonly used. Administered intra- or post-operatively. Intraoperative use: Post-operative use Administrated intra operatively on a filter paper or a sponge 25 or 50 mg/ml undiluted solution Time of exposure usually 5 minutes (shorter time has minimal effect with 5-FU) Rinse with approximately 20 ml of balanced salt solution Relative contraindication if epithelial problems present 5 mg injections. 0.1ml of 50 mg/ml undiluted solution Small calibre needle (e.g. 30 G needle on insulin syringe) Adjacent to but not into bleb (pH 9) Multiple injections possible - some evidence that less than a total of 3 injections has a minimal impact on scarring Mitomycin C: Dose: 0,1-0,5 mg/ml. Available in different preparation; care must be taken in diluting it to the desired concentration. Administered intraoperatively, or postoperatively 165-170 . Intraoperative use: Concentration: 0.2 - 0.4 mg/ml Administered intraoperatively on a filter paper or a sponge for 2-5 minutes Avoid contact with cut edge of conjunctive flap After application rinse with approximately 20 ml of balanced salt solution Ch. 3 - 37 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,
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1.5 - BLOOD FLOW 1.5.1 - VASCULAR F
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28) Flammer J, Orgul S, Costa VP, O
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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 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 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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