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TREATMENT OF GLAUCOMA

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TREATMENT OF GLAUCOMA Powered By Docstoc
					Treatment of
 Glaucoma
            Glaucoma
Glaucoma is
characterized
by high IOP
associated with
optic disk
cupping and
visual field loss
    Normal outflow through trabecular
 meshwork (large arrow) and uveoscleral
routes (small arrow) and related anatomy.
 In primary open-angle glaucoma,
aqueous outflow by these pathways
           is diminished.
In angle-closure glaucoma, the iris is
abnormally positioned so as to block
aqueous outflow through the anterior
    chamber (iridocorneal) angle.
Normal optic disc. Note the
distinct optic disc margins, the
well-demarcated cup, and the
healthy pink color of the
neuroretinal rim.
 The cup-to-disc ratio of this optic
 nerve is 0.6. Clinical correlation
 with the patient's history and
 examination is required to
 decide if this optic nerve is
 abnormal.
 Glaucomatous optic nerve cupping.
 The cup in this optic nerve is
 enlarged to 0.8, and there is typical
 thinning of the inferior neuroretinal
 rim, forming a "notch."
Visual Field Impairment
               (A)normal
               (B)loss of visual field in
                 the superior and
                 nasal portion
               (C)visual field loss
                 extends to superior
                 and inferior portions
               (D)Finally,extensive
                 damage to the entire
                 visual field occurs,
                 sparing the very
                 central portion of
                 vision.
Glaucoma classified according to
           etiology
• Primary glaucoma
  – Open-angle glaucoma      Chronic angle-closure
  – Angle-closure glaucoma
• Congenital glaucoma
                                             Siderosis
• Secondary glaucoma
                                      Trauma

  Neovascular glaucoma
                              Open-angle, trabecular
                              abnormality
           Treatment Goal
The goal of glaucoma treatment is to
 preserve the visual field of patients and
 prevent the loss of visual function that is
 associated with the disease.”

             Ref: Survey of Ophthalmology; 2003 Vol. 48(1): S1-S3
   THE FIRST TARGET

 ACHIEVING A LOW TARGET IOP
WHICH IS UNIFORM DAY AND NIGHT
  Target IOP: Definition
Target IOP may be defined as a pressure,
 rather a range of intraocular pressure
 levels within which the progression of
 glaucoma and visual field loss will be
 delayed or stoped

          Ref: Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57
The treatment options of glaucoma includes:
• Drugs
• Laser
• Operation
The treatment is decided by many factors:
  – Type of glaucoma
  – Stage of glaucoma
  – Damage done
  – Status of the other eye
  – Response to other treatment already taken
  – Patient compliance or reliability about taking
    drugs and follow up examination
Operation -Trabeculectomy
THE SECOND TARGET:

 VASOPROTECTION/
 NEUROPROTECTION
GLAUCOMA: OPTIC NERVE DAMAGE
               Rise in IOP


        Mechanical back pressure


   On the junction of optic nerve/retina


Reduce the blood supply to the optic nerve


          Loss of blood supply


                RGC loss
THE THIRD TARGET
     PERSISTENCY/
     COMPLIANCE
 WITH DRUG THERAPY IN
GLAUCOMA MANAGEMENT
Glaucoma Therapy: Persistency

Pharmacologic therapy for glaucoma can
be effective only if patients fill their
prescriptions (persistency) and take their
medications as directed (compliance)


                  Ref: Am. J. Ophthalmol 2004; 137: S3-S12
               So
• Let your patients have good
  compliance
  –Tell him what is glaucoma
  –How to cooperate with doctor
  –Check your treatment
                Differential diagnosis

• Acute conjunctivitis
• Acute angle-closure glaucoma
    (acute ACG)
                                                    Acute
 Symptoms        iridocyclitis    Acute ACG
                                                 conjunctivitis

                    Slow
   Vision         decrease         Toboggan         normal
                comparatively
                    usually
                                 Ophthalmalgia
Pain position     located in                     slight or not
                                 and migraine
                 ocular area

                                   Be often
Nausea and
                     No          accompanied          No
  vomit
                                     with

 Secretion           No               No         A great deal
                                                         Acute
  signs          iridocyclitis       Acute ACG
                                                      conjunctivitis
Congestio
               Ciliary or mixed    Ciliary or mixed   Conjunctival
   n

 Cornea             clarity            opaque            clarity

   KP              offwhite          pigmentary            No

Anterior
                 Not shallow           shallow        Not shallow
chamber
Aqueous                               Flare and
               Flare and cells                           Normal
 humor                                exudation
               Unclear furrow        Segmental
   Iris                                                  Normal
                  nodule            atrophy of iris
                                   Dilate, vertical
  Pupil        Shrink, irregular                         Normal
                                    oval shape
Intraocular
              Normal or low IOP       High IOP           Normal
 pressure
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