terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

Practical points for topical medical treatment 30,51 To minimize drainage into the nose or throat, patients should be instructed to use finger pressure exerted on the medial canthus for a minute or two following installation of the eye drop. Excess solution around the eye should be removed with a tissue and any medication on the hands should be rinsed off. Many studies are available to compare the IOP lowering efficacy and the safety of topical preparations. Published studies vary considerably in population sample, methodology, criteria for definition of the outcome, statistical analysis graphics and overall quality, making very difficult to draw conclusions and comparisons. Meta-analysis is not available for any of the drugs used for glaucoma treatment with the exception of beta blockers. The pre-post graph shown below is a useful tool to show the IOP changes induced by treatment and its use should be encouraged in publications. mmHg Fig. 3.3 - THE PRE -POST IOP GRAPH A simple graph can be used to show the IOP lowering effect. Different shapes/colors can be used to show different patient series or different observation times. Vertical and horizontal lines show respectively Pre and Post Treatment IOP levels of interest, here placed as examples at 15 and 21mmHg. Areas of desired effect under the oblique “no effect” line can thus be defined. The following pages outline the most frequently used anti-glaucoma medications, and emphasize their mode of action, dosage and side effects. They are to be considered as a general guide, and cannot be all-inclusive. The text does not contain all the drugs, nor all their indications, contraindications and side effects but only the most relevant ones. Before starting each treatment please carefully read the product information sheet. For each drug category: Action, Dosage and Administration, Indications, Major contraindications, Major side effects, Pregnancy and nursing mothers precautions, Drug interaction, Wash-out are summarized. When more than one drug is referred to under any heading, these are listed in alphabetical order. Ch. 3 - 8 EGS
MAIN FEATURES OF SIX FAMILIES OF ANTIGLAUCOMA AGENTS 3.3.1 ß Blockers Alpha-2 selective adrenergic agonists (Brimonidine) Prostaglandin derivatives Prostamides Topical CAIs Pilocarpine Dipivefrin Epinephrine IOP reduction efficacy +++ 20-25% ++ to +++ 20-25% ++++ (*) 25-30% + to ++ 15-20% +++ 20-25% +to++ 15-20% Cost + ++ +++ ++ + + Instillation frequency 1-2 times daily 2-3 times daily Once daily (*) 2-3 times daily 3-4 times daily 2-3 times daily Topical tolerability Topical allergies Preservative free preparations available Conjunctival hyperaemia Hypertrichosis Iris darkening Uveitis CME Corneal oedema Recurrence HSV keratitis Miosis, browache +++ +/- Yes +/- - +/- - - - - - ++ ++ No + to ++ - - - - - - - ++ to +++ +/- No + to ++ + to +++ ++ to +++ + to +++ + to +++ - +/- - +to+++ +/- No - +/- - - - +/- - +/- ++to+++ +/- Yes - +/- - - - - - +++ +++ ++ No - ++ to +++ - - - - ++ - Systemic effects: Bradyarrhythmias/hypotension Tachycardia/hypertension Bronchoconstriction Elevated serum lipids Increased falls in the elderly Apnoea in infants Drowsiness/anergy/fatigue Dry mouth + - +++ +++ ++ - ++ +/- - - - - - ++ +++ + to +++ - - - - - - - - - - - - - - - - - - ++ - - - - - - + - - - - - - Ch. 3 - 9 EGS CAIs = carbonic anhydrase inhibitors. CME: Cystoid macular edema *) Unoprostone: 2 times daily, 20% IOP reduction Where figures are not used, the scale 0 (minimum) to ++++ (maximun) is used
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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
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 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
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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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