terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

4.2 - PRIMARY OPEN-ANGLE GLAUCOMAS 4.2.1 - PRIMARY JUVENILE GLAUCOMA a) Medical therapy: any effective and well tolerated topical regimen. Pilocarpine causes fluctuating myopic shift, visual symptoms and headache particularly in the young and should be avoided. b) Surgery: early surgery recommended filtering procedure or trabeculotomy; consider antimetabolites c) Laser trabeculoplasty: not recommended due to poor and short-lived IOP lowering effect 4.2.2 - PRIMARY JUVENILE GLAUCOMA SUSPECT * The indication for therapy is relative * No well-documented scientific clinical trials with well-defined guidelines for treatment The risk of developing glaucoma increases with the number and strength of risk factors. The likelihood that these risk factors will contribute to the development of glaucomatous optic nerve damage should be carefully weighed against the risks of treatment (see Ch. 2.2). The potential benefit of treatment should outweigh the negative side effects of therapy on the patient’s vision, general health and quality of life since life expectancy is long. a) Medical therapy: if indicated, same as for primary juvenile glaucoma b) Surgery: not indicated c) Laser trabeculoplasty not recommended due to poor and short-lived IOP lowering effect d) Follow-up at intervals of 6-12 months with examination of: - Optic disc - Visual field - IOP - Optic Disc and/or Retinal Nerve Fibre Layer photographs or imaging initially and every 2-3 years If negative, F/U interval can be increased to 12-18 months 4.2.3 - PRIMARY OPEN-ANGLE GLAUCOMA (POAG/HPG) Refer also to Introduction II and Ch. 3.1 A target pressure is to be identified for each case (See also Ch. 3.1.1, 3.2 and FC) It is essential to involve the patient as an informed partner in decisions regarding management of their status. a) Medical treatment (see Flow Charts) 1. Mono therapy 2. Combination therapy when needed in selected patients b) Laser trabeculoplasty (LTP) c) Filtration Surgery with / without antimetabolites Adjunctive medical therapy when needed d) Insertion of aqueous drainage tubes / setons e) Cyclodestructive procedures Choice of primary therapeutic modality needs to be made on an individual patient basis. Ch. 4 - 4 EGS
4.2.4 - PRIMARY OPEN-ANGLE GLAUCOMA SUSPECT (POAG/HPG SUSPECT) Risks and benefits of treatment need to be weighed against the risk of the development of glaucomatous disc damage. The risk of developing glaucoma increases with the number and strength of risk factors. It is essential to involve the patient as a informed partner in decisions regarding management of their status. Management: The indication for any form of therapy is relative a) Medical therapy: any topical agent alone or in combination as long as well tolerated and effective Avoid adjunctive medical treatment unless strictly needed b) Laser trabeculoplasty: not usually indicated c) Filtering operation: not indicated d) Follow-up at intervals of 6 months initially, to be increased if all parameters remain normal with examination of: - Optic disc - Visual field - IOP - ONH and RNFL photographs initially and every 2-3 years 4.2.5 - NORMAL-PRESSURE GLAUCOMA (POAG/NPG) (See Introduction II and Ch. 3.1) There are few prospective clinical trials indicating clearly the advantages of treatment. Target pressure: in most cases a peak IOP = 8 mm - 15 mm Hg on diurnal curve or a 30% IOP reduction from baseline (see Ch. 3.2) a) Medical therapy: Any drug effective and tolerated, sufficient to reach the target IOP. Avoid medications with potential vasoconstrictive effects or with systemic hypotensive effects i.e. non selective betablockers. Oral calcium channel blockers are being investigated in selected patients. b Laser trabeculoplasty c) Surgery: in cases of progressive glaucomatous damage, in spite of maximal medical therapy or laser trabeculoplasty, or failure to reach target pressure. Intensive postoperative care with bleb manipulation may be needed to maintain low IOPs. Follow-up at intervals of 3 -12 months, with examination of: - Optic disc - Visual field - IOP - ONH and RNFL photographs initially and every 2-3 years 4.2.6 - NORMAL-PRESSURE GLAUCOMA SUSPECT (POAG/NPG SUSPECT) Observe theses patients carefully. Treatment is not indicated unless there is suggestion of disease progression. If disease progression is due to glaucoma, manage as under 4.2.5 a) Medical therapy indicated only when visual field / optic nerve head are worsening: use any drug effective and tolerated sufficient to reach the target IOP. Avoid medications with potential vasoconstrictive effects or with systemic hypotensive effects b) Laser Trabeculoplasty: not indicated. c) Filtering surgery: not indicated. Follow-up at intervals of 3 -12 months, with examination of: - Optic disc - Visual field - IOP - ONH and RNFL photographs initially and every 2-3 years Ch. 4 - 5 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
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2.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
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2.2.4 - PRIMARY OPEN-ANGLE GLAUCOMA
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2.3 - SECONDARY OPEN-ANGLE GLAUCOMA
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2.3.1.6 - Glaucoma due to intraocul
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2.4 - PRIMARY ANGLE-CLOSURE Primary
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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 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 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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