terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

1.2 - GONIOSCOPY Gonioscopy is a fundamental part of the comprehensive eye examination 1-3 (see FC V). Purpose of gonioscopy is to determine the topography of the anterior chamber angle. It is based on the recognition of angle landmarks, and must always consider at least the following: a) level of iris insertion, both true and apparent b) shape of the peripheral iris profile c) estimated width of the angle approach d) degree of trabecular pigmentation e) areas of iridotrabecular apposition or synechia 4 . 1.2.1 - ANATOMY Reference landmarks Schwalbe’s line: this is a collagen condensation of the Descemet’s membrane between the trabecular meshwork and the corneal endothelium and appears as a thin translucent line. Schwalbe’s line may be prominent and anteriorly displaced (posterior embryotoxon) or there may be heavy pigmentation over it. Confusion between a pigmented Schwalbe’s line and the trabecular meshwork may occur, particularly when the iris is convex. Indentation gonioscopy is helpful in these cases. Trabecular Meshwork (TM): this extends posteriorly from Schwalbe’s line to the scleral spur. Most difficulties concerning the examination of this region relate to the determination of features as normal or pathological, particularly pigmentation, blood vessels and iris processes. Pigmentation: pigment is found predominantly in the posterior meshwork. It is seen in adults (rare before puberty) and is highly variable. The most common condition associated with dense pigmentation are: pseudoexfoliation syndrome, pigment dispersion syndrome, previous trauma, previous laser treatment of the iris, uveitis and acute angle-closure attack. Blood vessels: these are often found in normal iridocorneal angles. They characteristically have a radial or circumferential orientation, have few anastomoses and do not run across the scleral spur. They can be seen most easily in subjects with blue irides. Pathological vessels are thinner, have a disordered orientation and may run across the scleral spur (neovascular membrane). Abnormal vessels are also seen in Fuch’s heterochromic iridocyclitis, rubeosis and chronic anterior uveitis. Schlemm’s canal: this is not normally visible, though it may be seen if it contains blood. Blood reflux from episcleral veins may occur in cases of carotid-cavernous fistulae, Sturge Weber syndrome, venous compression, ocular hypotony, sickle cell disease or due to suction from the goniolens. Iris processes: these are present in 1/3 of normal eyes and are frequently found in brown eyes and in youths. They follow the iris concavity and do not block the iris movements during indentation gonioscopy. When numerous and prominent they may represent a form of Axenfeld-Rieger syndrome. Ciliary band and iris root: the iris insertion is usually at the anterior face of the ciliary body, though the site is variable. The ciliary band may be wide, as in myopia, aphakia or following trauma, or narrow or absent as in hyperopia and anterior insertion of the iris. 1.2.2 - TECHNIQUES Gonioscopy is an essential part of the evaluation of all glaucoma patients. There are two principal techniques for viewing the anterior chamber angle: Ch. 1 - 9 EGS
Direct Gonioscopy The use of a contact goniolens like the Koeppe lens permits the light from the anterior chamber to pass through the cornea so that the angle may be viewed. Some peculiarities of this technique are: Patients must lie on their back Gives a direct view of the anterior chamber angle Good magnification Easy orientation for the observer Possible simultaneous comparison of both eyes Requires high magnification whit illuminated loupes or portable slit-lamp Angle view possible with direct ophthalmoscope by dialing high plus lens Indirect Gonioscopy The light from the anterior chamber is made to exit via a mirror built into a contact glass. Some peculiarities of this technique are: Patient must be at the slit lamp Indirect view of the anterior chamber angle Faster than direct gonioscopy during routine ophthalmological exam It can be used to see the fundus (using the central part of the lens) at the slit lamp. Inability to compare the two eyes simultaneously The most common Gonioscopy lenses: Direct Koeppe (contact fluid required) Layden (sized for infants; contact fluid required) Worst Indirect Posner or Zeiss or Sussman 4 mirror (contact fluid not required) Goldmann lens, 1 to 4 mirrors (contact fluid required) CGA 1.4 © Lasag (contact fluid required) Ch. 1 - 10 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 40 and 41: Other methods 22-25 : Air-puff tono
Page 42 and 43: References 1) Martin XD. Normal int
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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