terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

• Withdrawal of aqueous from vitreous body and posterior chamber Hyperosmotics are the most effective agents 5 . The patients must be evaluated for heart or kidney disease because hyperosmotics increase blood volume which increases the load on the heart. Some may alter glucose blood levels and should not be given to diabetics (see FC X). - Glycerol 1.0 - 1.5 g/Kg orally - Mannitol 1.0 - 1.5 g/Kg intravenously • Pupillary constriction - pilocarpine 1% or 2% or aceclidine 2% twice or three times within 1 hour Note: while the sphincter is ischaemic and the pupil non-reactive to light [sphincter paresis], multiple application of parasympathomimetics is not helpful, will not cause pupillary constriction and may cause forward rotation of the ciliary muscle, thereby increasing the pupillary block. Miotics in large doses can cause systemic side effects since they are absorbed transnasally and can cause abdominal cramps. It is now recognised that intensive parasimpathomimetic are no longer indicated to treat this condition. Miotics will constrict the pupil only after IOP has been lowered. - dapiprazole 0.5% (Glamidolo, Remydrial, RevEyes) or thymoxamine 0.5%. These are alpha-1 blockers that relax the dilator muscle. They do not reduce pupil size when the sphincter-muscle is paretic. Surgical treatment - Neodymium YAG laser iridotomy. Laser iridotomy should be attempted if the cornea is sufficiently clear. Some glaucomatologists prefer surgical iridectomy in all cases of manifest angle-closure glaucoma and use laser iridotomy only as prophylactic treatment of the contralateral eye and in cases of ‘occludable angle’. Argon laser iridotomy is rarely performed nowdays. - Surgical iridectomy 1) Transcorneal approach. Advantages: no conjunctival scarring a water-tight self-sealing incision is possible. Disadvantages: technically more difficult in dilated fixed pupil and flat anterior chamber. 2) Corneoscleral approach. Advantages: iridectomy can be ‘basal’. Disadvantages: conjunctival wound may lead to scarring compromising the outcome of a filtering procedure which may become necessary at a later stage insufficient wound closure and aqueous misdirection may occur in rare cases. General advantages of surgical iridectomy: it can be performed even when the cornea is cloudy it allows deepening of the anterior chamber, breaking freshly formed PAS. General disadvantages of surgical iridectomy: all the potential risks of any intraocular procedure. 4.4.1.2 - Intermittent Angle-Closure Glaucoma (IACG) Pupillary constriction, iridotomy, iridoplasty or lens extraction are to be considered according to the main mechanism determining angle occlusion. 4.4.1.3 - Chronic angle-closure glaucoma Medical treatment rarely effective If the synechial closure is less than half the circumference, iridectomy/iridotomy may be sufficient. Since complications of iridectomy/iridotomy are uncommon, its use as the initial procedure is justified in practically every case. Ch. 4 - 10 EGS
Argon laser trabeculoplasty is not indicated as it may increase synechial angle-closure. If IOP cannot be controlled, a filtering procedure is indicated. These eyes are more frequently prone to develop posterior aqueous misdirection and the necessary precautions must be taken when considering surgery. Early cataract removal may be considered and could relieve the problem 4.4.3 - THE “OCCLUDABLE” ANGLE; ACR (ANGLE-CLOSURE RISK) If fellow eye of primary angle-closure, treatment is clearly indicated, starting with laser iridotomy. All other cases must be assessed individually. In general, the risks of laser treatment are to be balanced againts the perceived risk of angle-closure. Ch. 4 - 11 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
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OCCLUDABLE ANGLE: “Occludable”
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2.5.3 - SECONDARY ANGLE-CLOSURE GLA
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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 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 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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