OCT e Glaucoma

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OCT e Glaucoma

OCT e Glaucomawww.amedeolucente.itNo commercial interests


Glaucoma 2 ͣcausa ͣͣͣdi cecità almondo, 1 ͣcausa ͣͣͣdi cecità irreversibileDati OMS 20102,5% over 40Caucasici *800.000 Italia2,5 milioni in USA3,36 milioni 2020* Bonomi L, et al. The Egna-Neumarkt Study, 19982


The Glaucoma ContinuumModificato da Weinreb R. et al A. J. Ophthalmol 2004; 138;458-4673


Retinal Ganglion CellWeinreb R. The Lancet 363; 1711, 2004Perdita /Cell5000-9000/anno ?4


OH v/s GlaucomaIOP + CCP+ ETA’+ PSD + CUP/DISK + Etnia + sesso + PA + ecc• Kass M A et al; OHTS Ocular Hypertension Treatmaent Study 2002• Miglior S. et al; Results of the European Prevention Study 20055


Relationship between MD and RGC number1 dB = 0.1 Log5000/9000Ganglion Cells/YearAdapted from Medeiros FA, Lisboa R, Weinreb RN, et al. A combined index of structure andfunction for staging glaucomatous damage. Arch Ophthalmol. 2012;130(5):E1-10.)6


Mean Deviation (dB)Average Thickness (µm) -------------------Estimated RCG count (x 10.000000 cells)A) At early stages ofdamage (high RGC counts),changes in estimated RGCcounts correspond torelatively smaller changesin MD (continuous line) andrelatively larger changes inaverage RNFL thickness(dashed line).MD dBKOOKB) At advanced stages ofdamage (low RGC counts),changes in estimated RGCcounts correspond torelatively large changes inMD, but only small changesin average RNFL thickness.Thickness µm7


CSFICombined StructureFunction IndexFelipe A. Medeiros, Renato Lisboa,Robert N. Weinreb, Christopher A.Girkin, Jeffrey M. Liebmann, Linda M.Zangwill. Arch Ophthalmol. 20128


Biblio CSFISpecificità 95%1. Sibota R, Sony P, Viney G, et al.Diagnostic capability of optical coherence tomography inevaluating the degree of glaucomatous retinal nerve fiberdamage. Invest Ophthalmol Vis Sci 2006;47(5):2006-10.2. Medeiros FA, Lisboa R, Weinreb RN, et al.A combined index of structure and function for stagingglaucomatous damage. Arch Ophthalmol. 2012;130 (5):E1-10.3. Harwerth RS, Wheat JL, Fredette MJ, Anderson DR. LinkingStructure and function in glaucoma. Prog Retin Eye Res. 2010;29(4):249-71.4. Medeiros FA, Zangwill LM, Anderson DR, et al. Estimating therate of retinal ganglion cell loss in glaucoma. Am J Ophthalmol. 2012;Jul 26. [Epub ahead of print].9


SD-OCT& Glaucoma• RNFL Retinal Nerve Fiber Layer• ONH Optical Nerve HeadGCC Ganglion Cell Complex• AS-OCT Anterior Segment OCT• SD-OCT & CV10


GCC Ganglion Cell Complex7 mm scan area 14.944 a-scan 0.58 secComplex scan pattern50% Ganglionariin maculaSchultze A, et al. Diagnostic ability of retinal ganglion cell complex ….Graefes Arch Clin Exp Ophthamol 2011 Jul; 249 (7) : 1039-4511


Ganglion cellsIPL15


Abnormal GCC in spite of normal RNFL ThicknessGaras A et al Reproducibility of retinal nerve layer and macular thickness eccOphthalmology 2010 Elsevier16


NormalRNFL Thickness v/s abnormal GCC17


Report Ganglion Cell OU Analysis18


Stages of Glaucoma & GCC19


SD-OCT & Glaucoma• RNFL Retinal Nerve Fiber Layer• ONH Optical Nerve Head• GCC Ganglion Cell Complex• AS-OCT Anterior Segment OCTSD-OCT& CV21


SD-OCT & CV• Zeiss Cirrus & Humphrey con FORUM• Heidelberg Spectralis & HEP con HEYEX• Optovue & Octopus Bundle Haag-Streit*22


HFA Visual Field and Cirrus RNFLCombined Report23


RNFL & Visual Field Combined OU Report24


Finite Element Modeling of the Lamina Cribrosa of theOptic Nerve Head in GlaucomaDevers Eye Institute / National Institute of Health Optic Nerve Head Research Laboratorydirected by Dr. Claude Burgoyne (Portland Oregon)26


Finite Element Modeling of the Lamina Cribrosa of theOptic Nerve Head in GlaucomaDevers Eye Institute / National Institute of Health Optic Nerve Head Research Laboratorydirected by Dr. Claude Burgoyne (Portland Oregon)27


Structural and functional recovery in juvenile open angleglaucoma after trabeculectomy C K S Leung, J Woo, M K Tsang and K K TseREcovery?REVERSIBLE?Fundus photographs, OCT optic nerve head scans (vertical cut) and Humphrey visual fieldpattern deviation plots of the left eye obtained the day before trabeculectomy (a) and 1week postoperatively (b). The red lines on the fundus photographs indicate the location ofthe OCT scans in the middle panel. Eye (Lond). 2006 Jan;20(1):132-4 28


Structural and functional recovery in juvenile open angleglaucoma after trabeculectomyC K S Leung, J Woo, M K Tsang and K K Tse Eye (Lond). 2006 Jan;20(1):132-4buffer-zone=A time interval in which optic nerve damage canbe reversed by appropriate interventions.Reversal is likely to be dependent on the degree of IOP reduction, the age of presentation,and may vary with the compliance of the lamina cribrosa and the composition ofsupporting tissue of retinal ganglion cells.Pre Op. 74.5 µmPost Op. 117 µm29


Reversibility of glaucomatous demangeBiblio1.Kotecha A, Siriwardena D, Fitzke FW, Hitchings RA, Khaw PT.Optic disc changes following trabeculectomy: longitudinal andlocalisation of change.Br J Ophthalmol 2001; 85: 956–961. | Article | PubMed | ISI | ChemPort |2.Aydin A, Wollstein G, Price LL, Fujimoto JG, Schuman JS.Optical coherence tomography assessment of retinal nervefiber layer thickness changes after glaucoma surgery.Ophthalmology 2003; 110: 1506–1511. Article PubMed ISI3.Tsai CS, Shin DH, Wan JY, Zeiter JH.Visual field global indices in patients with reversal ofglaucomatous cupping after intraocular pressure reduction.Ophthalmology 1991; 98: 1412–1419. | PubMed | ISI | ChemPort |30


Grazie per l’attenzione31

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