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Department of Ophthalmology
Faculty of Medicine UNILA/RSAM
Glaucoma
A group of disease that have in common a characteristic optic
neuropathy with associated visual field loss for which
elevated IOP is one of primary risk factors.
Normal IOP: 10-22 mmHg.
Decreased by miotics
Clinical examination
Funduscopy
Tonometry
Gonioscopy
Visual field (GOLDMAN PERIMETRI/HUMPREY
PERIMETRI)
Optical Coherence Tomography
Funduscopy
Tonometers
3. Inheritance
Level of IOP, outflow facility and disc size are inherited
Risk is increased by x2 if parent has POAG
Risk is increased x4 if sibling has POAG
4. Myopia
Theories of glaucomatous damage
Interference with
axoplasmic flow
Concentric excavation
1984
1994
All neural disc tissue is destroyed Atrophy of all retinal nerve fibres
Striations are absent
Disc is white and deeply excavated
Blood vessels appear dark and sharply defined
Progression of glaucomatous cupping
a. Normal (c:d ratio 0.2)
b. Concentric enlargement
(c:d ratio 0.5)
1. Beta blockers
2. Sympathomimetics
3. Miotics
4. Prostaglandin analogues
b. Conjunctival undermining
c d
c. Clearing of limbus
f. Paracentesis
Technique (2)
a b
a. Cutting of deep block -
anterior incision
b. Posterior incision
c d
d. Peripheral iridectomy
e f
e. Suturing of flap and
reconstitution of
anterior chamber
f. Suturing of conjunctiva
Filtration blebs
Type 1 Type 2
Flat, thin and diffuse
Thin and polycystic Relatively avascular
Good filtration Microcysts present
Good filtration
Type 3 Encapsulated
Flat Localized, firm cyst
Engorged surface vessels Engorged surface vessels
No microcysts
No filtration No filtration
Late bleb infection
Predispositions
Thin-walled, cystic bleb
Use of adjunctive antimetabolites
Bleb trauma
Blebitis Endophthalmitis
1. Pathogenesis
2. Classification
3. Intermittent
4. Acute congestive
5. Post congestive
6. Chronic
Anatomical predispositions
Increase in physiological
pupil block
3. Acute
Congestive - sudden total angle closure
Postcongestive - follows acute attack
5. Absolute
No PL following acute attack
Acute congestive angle-closure glaucoma
Signs
3. Topical therapy
Pilocarpine 2% to both eyes
Beta-blockers
Steroids
1. Pseudoexfoliation glaucoma
2. Pigmentary glaucoma
3. Neovascular glaucoma
4. Inflammatory glaucomas
5. Phacolytic glaucoma
6. Post-traumatic angle recession glaucoma
7. Iridocorneal endothelial syndrome
Pseudoexfoliation glaucoma
Secondary trabecular block open-angle glaucoma
Affects elderly, unilateral in 60%
Prognosis less good than in POAG
Treatment
Pathogenesis Signs
3. Chandler syndrome
Iris atrophy in 40%
Corneal changes predominate
Progressive iris atrophy