terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

small - size mid - size large - size C/D=0,2 C/D=0,5 C/D=0,8 Fig. 2a (above) Optic nerve heads with different disc area but with the same rim area and same retinal nerve fiber number: small size disc (disc area less than 2 mm 2 and C/D=0.2), mid size disc (disc area between 2 and 3 mm 2 , C/D=0.5) and large disc (disc area greater than 3 mm 2 and C/D=0.8). A B Normal ONH C Fig. 2b Progression of glaucomatous damage at the optic disc: A) Localized and diffuse nerve fiber loss. B) Diffuse or concentric nerve fiber loss. C) Localized nerve fiber loss (polar notches). D) Localized nerve fiber loss (notch). D Ch. 1 - 17 EGS
Fig. 3 Optic disc hemorrhage. Beta Zone Alpha Zone Fig. 4 ONH with parapapillary atrophy: Alpha dystrophy is located peripheral to beta dystrophy, characterized by irregular hypopigmentation and hyperpigmentation; Beta dystrophy is adjacent to the optic disc edge, outer to the Elshnig rim, with visible sclera and visible large choroidal vessels. 1.3.1.b - Optic disc hemorrhages The prevalence of small hemorrhages related to the optic disc has been estimated at 0 to 0.21% in the normal population and 2.2 to 4.1% in glaucomatous patients; they may be more common in normal-tension glaucoma (up to 40%). Since the prevalence of disc hemorrhage is low in the normal population, their presence is very likely to be pathological, especially if recurring. It is a sign of local vascular damage 8,9 (Fig. 3). 1.3.1.c - Parapapillary atrophy 10-12 A temporal crescent of parapapillary atrophy is common (80% in the normal population). However, the frequency and area covered increases in glaucoma. Parapapillary atrophy is least frequent in normal eyes in the nasal disc sector. The site of the largest area of atrophy tends to correspond with the part of the disc with most neuroretinal rim loss. The extent of atrophy may be greater in NPG. Because some degree of atrophy is present in many normal eyes, a large area of atrophy should be regarded as an extra clue, rather than as a definite sign of local vascular damage associated with glaucoma (Fig. 4). 1.3.1.d - Acquired baring of circumlinear vessels An early sign of acquired rim thinning is a circumlinear vessel becoming bared. A circumlinear vessel is a small arteriole or vein that lies superficially on the neuroretinal rim, at its inner edge, and leaves the disc towards the macula; at least one is present in about 50% of eyes. As the rim narrows the loss of tissue leaves this vessel isolated, or ‘bared’. It may then remain superficial or come to lie on the inner slope of the rim or on the cup floor (Fig. 5). 1.3.1.e - Appearance of the retinal nerve fibre layer The nerve fibre layer (NFL) is best seen with a 78D or 90D lens or a contact lens at the slit lamp with a bright, rectangular, green light. The fibre bundles are seen as silver striations. From about two discs diameters from the disc the NFL thins and feathersout. Slit-like, groove-like, or spindle-shaped apparent defects, narrower than the retinal vessels, are seen in the normal fundus. The NFL becomes less visible with age, and is more difficult to see in lightly pigmented fundi. Defects are best seen within two disc diameters of the disc. Wedge and slit defects (wider than retinal vessels) are more apparent in early disease, when there is little generalized thinning of the NFL, and are seen as dark bands extending from the optic disc. Generalized thinning of the NFL, with a loss of brightness and density of striations, is a difficult sign to objectively confirm. When the NFL is thinned the blood vessel walls are sharp and the vessels appear to stand out in relief against a matt back- Ch. 1 - 18 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 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 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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