terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

OCCLUDABLE ANGLE: “Occludable” is not an objective evidence - based finding but a clinical diagnosis. Since an occludable angle is defined as one that has high risk of closure, it must be treated with iridotomy/iridectomy to eliminate the pupillary block component. If the iridotomy is patent, should the angle not deepen, iridoplasty may be considered, depending on the main mechanism underlying the risk of angle occlusion. Topical pilocarpine or dapripazole treatment should be considered whilst awaiting iridotomy / iridectomy. NARROW ANGLE: The term “narrow angle glaucoma” does not describe whether the main cause of IOP increase is primary impairment of trabecular outflow facility or mechanical obstruction of the trabeculum by iris apposition or synechial closure. Both mechanisms may co-exist in an eye with a narrow anterior chamber angle. Therefore the term “narrow angle glaucoma” should be avoided as non-specific. If an occludable angle is present (i.e. in addition to POAG), this should be referred as POAG with an occludable angle or with risk of angle-closure (See also Ch. 2.4.3). If intermittent angle-closure is present, the condition should be considered, and treated, as angle-closure glaucoma. If a case of POAG has a narrow angle, it should be labeled as POAG with narrow angle approach. Ch. 2 - 17 EGS
2.5 - SECONDARY ANGLE-CLOSURE GLAUCOMAS Angle-closure glaucomas are clinically divided into the acute and chronic forms. The pathogenesis is however many fold and varies according to the underlying condition. By definition, in acute angle-closure, the chamber angle is closed by iridocorneal apposition that can be reversed, whereas in chronic secondary angle-closure, the angle-closure is irreversible due to peripheral anterior synechiae. 2.5.1 - SECONDARY ANGLE-CLOSURE GLAUCOMAS WITH PUPILLARY BLOCK Etiology: The following is a limited list of other etiology for relative or absolute pupillary block: Swollen lens (cataract, traumatic cataract) Anterior lens dislocation (trauma, zonular laxity; Weil-Marchesani’s syndrome, Marfans’s syndrome etc.) Posterior synechiae, seclusion or occlusion of the pupil Protruding vitreous face or intravitreal silicone oil in aphakia Microspherophakia Miotic-induced pupillary block (also the lens moves forward) IOL-induced pupillary block (ACL, anteriorly dislocated PCL) 14 Pathomechanism: Pupillary block pushes the iris forward to occlude the angle. In iritis or iridocyclitis, the development of posterior synechiae may lead to absolute pupillary block with consequent forward bowing of the iris or “iris bombé”. Acute secondary angle-closure glaucoma may result. Features: IOP > 21 mmHg Disc features compatible with glaucoma 2.5.2 - SECONDARY ANGLE-CLOSURE GLAUCOMA WITH ANTERIOR “PULLING” MECHANISM WITHOUT PUPILLARY BLOCK Etiology: Neovascular glaucoma where the iridotrabecular fibrovascular membrane is induced by ocular microvascular disease Iridocorneal Endothelial (I.C.E.) Syndrome, with progressive endothelial membrane formation and progressive iridotrabecular adhesion Peripheral anterior synechiae, due to prolonged primary angle-closure glaucoma; this is theoretically a primary glaucoma. Epithelial and fibrous ingrowth after anterior segment surgery or penetrating trauma Inflammatory membrane After argon laser trabeculoplasty (ALT), early and late peripheral anterior synechiae and endothelial membrane covering the trabecular meshwork Aniridia Endothelial Posterior polymorphous dystrophy Pathomechanism: The trabecular meshwork is obstructed by iris tissue or a membrane. The iris and/or a membrane is progressively pulled forward to occlude the angle. Features: IOP > 21 mmHg Disc features compatible with glaucoma Ch. 2 - 18 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
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 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 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
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4.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
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4.2.7 - OCULAR HYPERTENSION (OH) Al
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4.3.1.7 - Glaucoma associated with
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• Withdrawal of aqueous from vitr
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4.5 - SECONDARY ANGLE-CLOSURE GLAUC
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4.5.3 - SECONDARY ANGLE-CLOSURE GLA
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NOTES
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NOTES
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NOTES
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