terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

Other methods 22-25 : Air-puff tonometry The noncontact tonometer deforms the corneal apex by means of a pulsed jet of air. The exposure time is between 1 and 3 msec. Since this is 0.002 of a cardiac cycle, the ocular pulse can be a significant source of variability. Topical anathesia is not necessary. Air-puff tonometry is not recommended for evaluating patients with glaucoma. Pneumatonometry The sensor measures air pressure. The measurements are well correlated with those made with the Goldmann applanation tonometer, with a tendency to higher IOP estimates. It is useful in eyes with scarred, edematous and irregular cornea. Tono-Pen This instrument has software that automatically selects the acceptable measurements and rejects the inappropriate ones. An average of at least three good IOP measurements are determined and displayed. It is useful in patients with corneal edema or irregularities 10-13 . The relationship between CCT and different types of glaucoma is under scrutiny; in some studies a correlation between thicker corneas and OH as well as between thinner corneas and NPG were found 11,32,33,34 . INFLUENCE OF CORNEAL STATUS ON THE INTRAOCULAR PRESSURE VALUE MEASURED W ITH THE GOLDMANN APPLANATION TONOMETER 26-31 CORNEA STATUS IOP READING Thinner Erroneously high Thicker + Error Range 0.2-0.7 mmHg/10 µm Erroneously low + Edema + Increased power 1mmHg/3 dioptres Decreased power 1mmHg/3 dioptres Astigmatism with the rule 1mmHg/4 dioptres Astigmatism against the rule 1mmHg/4 dioptres Astigmatism irregular +/- +/- Tear film too abundant + Tear film insufficient + Corneal Refractive surgery* Lamellar cut -/ Radial keratotomy -/ Surface excimer laser (PRK)** MYOPIC ++ Intrastromal excimer laser (LASIK)**MYOPIC ++ Note: to minimize the reading errors of IOP, the biprism should be aligned to the center of the cornea. In case of high or irregular astigmatism, two measurements should be made, the first with the biprism in horizontal position and the second in vertical position and readings averaged. Measurement of IOP with a Tonopen XL (tm) may be useful in eyes with corneal surface irregularities. * Corneal refractive surgery alters tonometry reading since it modifies thickness, curvature and structure of the cornea ** Depends on attempted correction; a precise relationship is not defined yet. Ch. 1 - 4 EGS
Central corneal thickness measurements are valuable: - only to correct for Goldmann applanation IOP measurement - if interpreted within the general variability of tonometry readings - especially when treatment of ocular hypertension is considered - when clinical findings do not match with IOP - very little for management of established glaucoma - after corneal refractive surgery Tonography and Water Drinking Tonography is a clinical, non invasive method for estimating the outflow facility of aqueous humor. Today it is rarely used and it has virtually disappeared from clinical pratice 3,4,14,15 . Water-drinking has been used to assess indirectly the ouflow facility. Patients are asked to drink a fixed amount of water (usually 1 liter) in a short time (usually 5 minutes) and the IOP is measured during the first hour(s). If the IOP raises substantially the test is considered positive 3,35 . IOP diurnal variations can be substantial. IOP diurnial variations are larger in glaucoma patients. Measurement artefacts are important variabiles. Single IOP measurements are made during only a few seconds of a patient’s day. Ch. 1 - 5 EGS
Page 2 and 3: ISBN: 88-87434-13-1 Editrice DOGMA
Page 4 and 5: ACKNOWLEDGEMENT This work was made
Page 6 and 7: 2.2.5 - Primary Open-Angle Glaucoma
Page 8 and 9: Foreword These Definitions and Guid
Page 10 and 11: INTRODUCTION The aim of the book is
Page 12 and 13: Since resources are limited worldwi
Page 14 and 15: II - RANDOMIZED CONTROLLED TRIALS F
Page 16 and 17: II.3 - COLLABORATIVE NORMAL TENSION
Page 18 and 19: No stratification for stage of dise
Page 20 and 21: II. 6. 3 - from CNTG 1. Therapy tha
Page 22 and 23: References 1) The Ocular Hypertensi
Page 24 and 25: I - QUESTIONS TO ASK TO YOUR GLAUCO
Page 26 and 27: III - ABNORMAL THRESHOLD VISUAL FIE
Page 28 and 29: V - GONIOSCOPIC OPEN ANGLES SOME DI
Page 30 and 31: VII - TREATMENT STEPLADDER JUVENILE
Page 32 and 33: IX - MONOTHERAPY (in alphabetic ord
Page 34 and 35: XI - MANAGEMENT ACUTE ANGLE CLOSURE
Page 36 and 37: XIII - ANTIMETABOLITES FOR WOUND MO
Page 38 and 39: CHAPTER 1 PATIENT EXAMINATION
Page 42 and 43: References 1) Martin XD. Normal int
Page 44 and 45: 1.2 - GONIOSCOPY Gonioscopy is a fu
Page 46 and 47: 1 2 3 4 Fig. 1 Dynamic indentation
Page 48 and 49: The Spaeth classification Insertion
Page 50 and 51: References 1) Palmberg P. Gonioscop
Page 52 and 53: small - size mid - size large - siz
Page 54 and 55: Fig. 5 A) Cirumlinear vessel, B) Ba
Page 56 and 57: 1.3.4.3 - OCT The Optical Coherence
Page 58 and 59: 31) Carpineto P, Ciancaglini M, Zup
Page 60 and 61: central 24 or 30 central degrees re
Page 62 and 63: A retinal sensitivity value worse t
Page 64 and 65: 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 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 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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