glaukoma
DESCRIPTION
mataTRANSCRIPT
Dr. Purjanto Tepo Utomo, SpMBagian IP Mata FK UGM /RSUP Dr. Sardjito
Yogyakarta
GLAUCOMA
Second most commonly cause of most commonly cause of visual lossvisual loss in elderly
Affects- 10 % african American > 70- 2% Caucasian > 70
Early detection and treatment can prevent blindness
Glaucoma
Definition : a group of diseases that have in common a characteristic optic neuropathy with associated visual function loss. Although elevated intraocular oressure (IOP) is one of the primary risk factors, its presence or absence does not have a role in the definition of the disease.
GLAUCOMA : Risk Factor
IOPIOP maybe high African racialracial heritage Advanced ageage Family historyFamily history of glaucoma Hypertension, Diabetic, Myopia
Types Of Glaucoma
Primary Open Angle Glaucoma (POAG)POAG)Most common type in elderly
Primary Angle closure glaucoma (PACG)PACG)
Secondary GlaucomaSecondary Glaucoma- Lens induced- Post traumatic glaucoma- Infection
POAG
Clinical features : Insidious in onset Slowly progressive Painless Visual field loss Assymetri of the neuroretinal rim area Focal thinning or notching of the
neuroretinal rim Optic disc hemorrhages Change of the disc rim appearance
POAG : MEDICAL TREATMENT
Halt visual field lossHalt visual field loss Prevent further optic nerve damagePrevent further optic nerve damage Use medication to lower IOP Asses visual field at least once a year
POAG MEDICAL TREATMENT
Beta Blocker (Timolol, levobunolol, metipranolol, carteolol, betaxolole)
Adrenergic Agonist (Epinephrine, dipivefrin, apraclonidine, brimonidine)
Cholinergic agonist (Pilocarpine,Carbachol)
Prostaglandin analog (latanoprost, travoprost, bimatoprost, unoprostone))
Carbonic anhydrase inhibitors (Acetazolamide)
TOPICAL BETA BLOCKERS SIDE EFFECTS Dry eyes Impotence Depression, confussion Bradycardia Worsening of myasthenia gravis Bronchospasm Congestive heart failure
TOPICAL ADRENERGIC AGONIST SIDE EFFECTS
Red eyes Head ache Anxiety Tremor Increased blood pressure Tachyarrhytmias
TOPICAL CHOLINERGIC AGONISTS SIDE EFFECTS
Brow ache Increased bronchial secretion Decreased dark adaptation Diarrhea Nausea, vomiting Apnea
TOPICAL PROSTAGLANDIN ANALOG SIDE EFFECTS
OCULAR IRRITATION Minimal systemic effects
Carbonic anhydrase inhibitor side effects
Malaise, anorexia, depression Serum electrolyte abnormalities Renal calculi Blood dyscrasias
POAG SURGICAL TREATMENT
Laser surgery Filtering surgery Cyclodestructiive surgery of ciliary
body Placemen ot drainage device
PRIMARY ANGLE CLOSURE GLAUCOMA
Increased incidence with age More common in some asian groups Less common in some Caucasian
groups Risk factors : female sex and hyperopia
ACUTE GLAUCOMA SYMPTOM
Severe Ocular pain Frontal headache Blurred vision with halos seen
around lights Nausea, vomiting
Acute glaucoma
ACUTE GLAUCOMA INITIAL TREATMENT
Pilocarpine 2% gtt q 15 minh x 2 Acetazolamide 500 mg po or IV Oral glycerine or isosorbide 1 cc/kg
bodyweight IV mannitol 20% 300 – 500 cc
Diabetes Mellitus
Increased every year 8000 become blind from retinopathy
annualy
Visual loss is late symptom of diabetic retinopathy
Currently much disease is detected too late for effective laser surgery
PATHOGENESIS
High blood sugar levels may affect retinal capillaries
NONPROPLIFERATIVE RETINOPATHY (NPDR)
Retinal blood vessel leak Leakage into macula may reduce vision
PROLIFERATIVE RETINOPATHY (PDR)
Neovascularization Fibrous proliferation Bleeding and traction Retinal detachment, blindness
DM
Laser surgery for retinopathy is most effective before visual loss occurs
Rubeosis Iridis
Vitreous hemorrhages
Retinal detachment