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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
Thanks!

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