CORELATION OF THE CHANGES BETWEEN CORELATION OF THE CHANGES BETWEEN THE IRIDOCORNEALTHE IRIDOCORNEAL--ANGLE ANGLE AND OTHER AND OTHER

PARAMETPARAMETEERS AT THE RS AT THE NEOVASCULAR GLAUCOMANEOVASCULAR GLAUCOMA

Halil Ajvazi,Halil Ajvazi, Ilhami Goranci, Ardiana Goranci, Ilhami Goranci, Ardiana Goranci, Dafina Goranci,Dafina Goranci,

Bekim Kastrati,Bekim Kastrati, Mimoza IsmailiMimoza Ismaili..

18.06.2010 1

Neovascular glaucoma-NVG is an atrophic Neovascular glaucoma-NVG is an atrophic optic neuropathy resulting from the optic neuropathy resulting from the neovascularization of the iridocorneal neovascularization of the iridocorneal angle-ICA by increasing the intraocular angle-ICA by increasing the intraocular pressure-IOP, associated with the changes pressure-IOP, associated with the changes in the retina and papillae nervi optici-PNO.in the retina and papillae nervi optici-PNO.

To analyze the findings in theTo analyze the findings in the iridocorneal iridocorneal angle at the NVG andangle at the NVG and corelation between corelation between IOP, PNO and visual acuity. IOP, PNO and visual acuity.

NEOVASCULAR GLAUCOMA NEOVASCULAR GLAUCOMA IntroductioIntroductionn IntroductioIntroductionn

PurposePurpose PurposePurpose

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Neovascular glaucoma-NVG is an atrophic Neovascular glaucoma-NVG is an atrophic optic neuropathy resulting from the optic neuropathy resulting from the neovascularization of the iridocorneal neovascularization of the iridocorneal angle-ICA by increasing the intraocular angle-ICA by increasing the intraocular pressure-IOP, associated with the changes pressure-IOP, associated with the changes in the retina and papillae nervi optici-PNO.in the retina and papillae nervi optici-PNO.

To analyze the findings in theTo analyze the findings in the iridocorneal iridocorneal angle at the NVG andangle at the NVG and corelation between corelation between IOP, PNO and visual acuity. IOP, PNO and visual acuity.

NEOVASCULAR GLAUCOMA NEOVASCULAR GLAUCOMA IntroductioIntroductionn IntroductioIntroductionn

PurposePurpose PurposePurpose

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Anatomy of the ICAAnatomy of the ICA

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Normal ICANormal ICA

Grade IGrade I

Grade IIGrade IIGrade IIIGrade III

ICA Four Gr ICA Four Gr

Grade 0 Grade 0 Grade IV Grade IV

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MMethodsethods MMethodsethods

• We have performed We have performed relevant relevant biomicroscopic, biomicroscopic, gonioscopic, gonioscopic,

tonometric and tonometric and ophtalmoscopic ophtalmoscopic examination as examination as well as visual acuty well as visual acuty test. test.

• We have also usedWe have also used the statistical the statistical methods of the methods of the processing and processing and analyzisanalyzis..

• We have performed We have performed relevant relevant biomicroscopic, biomicroscopic, gonioscopic, gonioscopic,

tonometric and tonometric and ophtalmoscopic ophtalmoscopic examination as examination as well as visual acuty well as visual acuty test. test.

• We have also usedWe have also used the statistical the statistical methods of the methods of the processing and processing and analyzisanalyzis..

Material Material Material Material

• In this study were In this study were included 116 included 116 patints with NVG, patints with NVG, of whom 75 or of whom 75 or (64,7%) male and (64,7%) male and 41 or (35,3%) 41 or (35,3%) female, treated female, treated during the period during the period of time from of time from January 2000 until January 2000 until February 2010. February 2010.

• In this study were In this study were included 116 included 116 patints with NVG, patints with NVG, of whom 75 or of whom 75 or (64,7%) male and (64,7%) male and 41 or (35,3%) 41 or (35,3%) female, treated female, treated during the period during the period of time from of time from January 2000 until January 2000 until February 2010. February 2010.

NEOVASCULAR GLAUCOMA NEOVASCULAR GLAUCOMA

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General data of the examined patinentsCases of glaucoma treatment and management in Kosovo 2000-2010 According to the type of structure

Table. 1.

Sec.

glaucoma

N % %

Congenital Glaucoma congenitalis 132 4.71

Glaucoma simplex 713 25.46

Glaucoma pigmentosa 36 1.29

Primary Glaucoma capsularis 484 17.29

Glaucoma angularis acuta 246 8.79

Glaucoma angularis chronica 324 11.57

Total primary 1803 64.39

Glaucoma secundum acuta 252 9.00 29.1

Glaucoma secundum chronica 342 12.21 39.5

Glaucoma absolutum 155 5.54 17.9

Secondary Glaucoma neovascularis 116 4.14 13.4

Total secondary 865 30.89 100.0

Total 2800 100.00

Glaucoma all cases Type of glaucoma

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• According toAccording to the the loloccalizalizaattionion, NV, NVGG found constantly to both found constantly to both eyes= OU (oculus utergue) in 73 cases or 62,9% in the right eyes= OU (oculus utergue) in 73 cases or 62,9% in the right eye = OD (oculus dexter) 21 cases or 18,1% , whereas in the eye = OD (oculus dexter) 21 cases or 18,1% , whereas in the left eye = OS (oculus sinister) 22 cases or 19,0% to all NVG left eye = OS (oculus sinister) 22 cases or 19,0% to all NVG that were examined.that were examined.

• According to gender, NVG found frequently to male, 75 cases According to gender, NVG found frequently to male, 75 cases or 64,7% , against 41 cases or 35,3% in female.or 64,7% , against 41 cases or 35,3% in female.((See tSee tab.ab.))

NVG-According to the sex and eyesTab. 2.

OD OU OS N %f 8 24 9 41 35.3

m 13 49 13 75 64.7N 21 73 22 116 100.0Total % 18.1 62.9 19.0 100.0

Sex NVG- localization Total

NVG OD18%

OU=63%

OS19%

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NVG =The most affected age

Table. 2.

Age in yares OD OU OS N %10-19 1 1 0.9

20-29 1 1 0.9

30-39 3 3 6 5.2

40-49 2 2 4 3.4

50-59 1 19 2 22 19.0

60-69 12 38 16 66 56.970-79 3 9 4 16 13.8

Total: 21 73 22 116 100.0

Mean age 59.0 60.4 65.4 61.1

SD. 12.6 11.7 4.4 11.0

Maximal age 77 77 75 77

Minimal age 30 16 57 16

NVG Total

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NEOVASCULAR GLAUCOMANEOVASCULAR GLAUCOMA

The mean age of the patients with the The mean age of the patients with the changes in the ICA was 61.1 years and changes in the ICA was 61.1 years and varied from 17-77 years. Our study varied from 17-77 years. Our study found that most affected age was from found that most affected age was from 60-69 years.60-69 years.At the ICA, we have clasified four At the ICA, we have clasified four stagesstages:: I I - - IV and ascertained that there is a IV and ascertained that there is a high and positive corelation between high and positive corelation between stage of the ICA and IOP which was stage of the ICA and IOP which was varied from 25 mmHg till 59 mmHg. varied from 25 mmHg till 59 mmHg.

Results Results Results Results

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Classification of the vasculazation Classification of the vasculazation evolution in the irido-corneal angleevolution in the irido-corneal angle

• According to Wand are described 4 According to Wand are described 4 stadiastadia

• Iris initial rubeozis• Iris moderated rubeozis• Iris advanced rubeozis• Neovascular glaucoma

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Neovascular glaucoma-NVGNeovascular glaucoma-NVG

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• Reuslts of the IOP, have also Reuslts of the IOP, have also determined the ocular clinical determined the ocular clinical state ofstate of::

• compensation, compensation, • subcompensation and subcompensation and • decompensation. decompensation.

NEOVASCULAR GLAUCOMANEOVASCULAR GLAUCOMAResults Results Results Results

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IOIOP= compensation tendency at the NVGP= compensation tendency at the NVG

Schematic presentation

NVG – THE GRADE OF CO., DE., AND SUBCOMPENSATION ACCORDING TO THE TENDECY OF THE IOP FOLOWING TREATMENT

Grade of

compensationStagnation

13 10 decompensation 0 6 20

29 10 subcompensation 7 6 1

29 13 compensation 0 7 61

Tendency-reductionTendency-reduction Tendency-growth

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CORELATION OF THE CHANGES BETWEEN THE CORELATION OF THE CHANGES BETWEEN THE IRIDOCORNEALIRIDOCORNEAL--ANGLE ANGLE AND AND IOPIOP

• Connection between tonus and stadia of the angle is shown in the following graphic. The more high the stage of the ICA was, the more high the IOP was too, which moved from 21,9 mmHg in the first stadia up to 58.8 mmHg in the four stage. Therefore, there is a high and positive correlation between angle stadia and IOP.

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NVG - /

-

IOP ACCORDING TO THE STAGE OF THE ANGLE – LINEAR CORELATION

24.926.3

36.9

58.8y = 6.63x + 13.15

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

60.0

I II III IV

AV

ER

AG

E m

mH

g o

f th

e IO

P

ICA - stage & IOP

CORELATION OF THE CHANGES BETWEEN THE CORELATION OF THE CHANGES BETWEEN THE IRIDOCORNEALIRIDOCORNEAL--ANGLE ANGLE AND AND IOPIOP

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NVG - Visual acuity and ICA stages

73.4 %92.3 % 96.7 % 100 %

amaourosis

0.0

20.0

40.0

60.0

80.0

100.0

I II III IV

ICA stage and Visual acuity

%

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CORELATION OF THE CHANGES BETWEEN THE CORELATION OF THE CHANGES BETWEEN THE IRIDOCORNEALIRIDOCORNEAL--ANGLE ANGLE AND AND Visual acuityVisual acuity

NVG – Visual AcuityTab. 4.Damage

ratio VA=Ratio OD OS N %%

amaurosis 21 27 48 25.4

L+P- 5 6 11 5.8

Big damages

L+P+ 11 9 20 10.6 84.7

˂ 0.034 21 17 38 20.1

0.05-0.083 13 9 22 11.6

0.1-0.3 10 11 21 11.1

Small damages

0.4-0.5 4 7 11 5.8

0.6-1.0 9 9 18 9.515.3

Total: 94 95 189 100.0

EYES Total

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CORELATION OF THE CHANGES BETWEEN THE CORELATION OF THE CHANGES BETWEEN THE IRIDOCORNEALIRIDOCORNEAL--ANGLE ANGLE AND AND Visual acuityVisual acuity

NVG – Visual Acuity

25.4

5.8 10.620.1

11.6 11.1

84.7 %

5.8 9.5

15.3 %

0.010.020.030.040.050.060.070.080.090.0

amau

rosi

s

L+P

-

L+P

+

Su

b 0

.03

4

0.05

-0.

083

0.1-

0.3

Tot

al

0.4-

0.5

0.6-

1.0

Tot

al

Big damages

Small damages

%

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CORELATION OF THE CHANGES BETWEEN THE CORELATION OF THE CHANGES BETWEEN THE IRIDOCORNEALIRIDOCORNEAL--ANGLE ANGLE AND AND VISUAL ACUITYVISUAL ACUITY

The evolutive stage has been compared with an The evolutive stage has been compared with an average average IOP and has been ascertained that the IOP and has been ascertained that the more IOP is more IOP is elevated, the more evolutive stage elevated, the more evolutive stage is elevated too is elevated too

from initial stage to absolute stage to the from initial stage to absolute stage to the PNO.PNO.Graphicon

Correlation between the evolutiv stage to the PNO and IOP

y = 2.14x + 16.86

0.05.0

10.015.020.0

25.030.0

35.040.0

Stage: Initial; Manifest; Evolution; Inveterate; Fer-absolute; Absolute.

An

ave

rage

IO

P

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The damages of the visual acuity The damages of the visual acuity according according to the evolutive stages of the ICAto the evolutive stages of the ICA

NVG

Visual acuity in the changes of the ICA

94.6 %

84.7 % 84.5 %

100.0 %

75.0

80.0

85.0

90.0

95.0

100.0

105.0

1. With the goniosinechi

2. With the neovascularization

3.ICA

narrow

4. With the fibrovascular

membrane

%

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N E O V A S C U L A R G L A U C O M AN E O V A S C U L A R G L A U C O M AN E O V A S C U L A R G L A U C O M AN E O V A S C U L A R G L A U C O M A

ConcluisionConcluision

-- All necessary measurements should be taken All necessary measurements should be taken in order to prevent neovascular appearancein order to prevent neovascular appearance,, spread and development in the ICA of etiology spread and development in the ICA of etiology whatever, because such whatever, because such precautionsprecautions will will enable us to enable us to managemanage the elevation of the IOP the elevation of the IOP with direct influence at PNO and visual acuity with direct influence at PNO and visual acuity and and by doing so we shallby doing so we shall be be able to able to successfully managing the NVG which, successfully managing the NVG which, otherwise will be with irreversible and heavy otherwise will be with irreversible and heavy consequences. consequences.

ConcluisionConcluision

-- All necessary measurements should be taken All necessary measurements should be taken in order to prevent neovascular appearancein order to prevent neovascular appearance,, spread and development in the ICA of etiology spread and development in the ICA of etiology whatever, because such whatever, because such precautionsprecautions will will enable us to enable us to managemanage the elevation of the IOP the elevation of the IOP with direct influence at PNO and visual acuity with direct influence at PNO and visual acuity and and by doing so we shallby doing so we shall be be able to able to successfully managing the NVG which, successfully managing the NVG which, otherwise will be with irreversible and heavy otherwise will be with irreversible and heavy consequences. consequences.

18.06.2010 22

A B S T R A A B S T R A C TC T• Introduction:Introduction: Neovascular glaucoma-NVG is an atrophic optic neuropathy resulting from Neovascular glaucoma-NVG is an atrophic optic neuropathy resulting from

the neovascularization of the iridocorneal angle-ICA by increasing the intraocular the neovascularization of the iridocorneal angle-ICA by increasing the intraocular pressure-IOP, associated with the changes in the retina and papillae nervi optici-PNO.pressure-IOP, associated with the changes in the retina and papillae nervi optici-PNO.

• Purpose: Purpose: To analyze the findings in the iridocorneal angle at the NVG and corelation To analyze the findings in the iridocorneal angle at the NVG and corelation between IOP, PNO and visual acuity. between IOP, PNO and visual acuity.

• Material and methods: Material and methods: In this study were included 116 patints with NVG, of whom 75 In this study were included 116 patints with NVG, of whom 75 or (64,7%) male and 41 or (35,3%) female, treated at the Eye Clinic in Prishtina, or (64,7%) male and 41 or (35,3%) female, treated at the Eye Clinic in Prishtina, University Clinical Center-Kosovo, during the period of time from January 2000 until University Clinical Center-Kosovo, during the period of time from January 2000 until February 2010. We have performed relevant biomicroscopy, gonioscopy, tonometry, February 2010. We have performed relevant biomicroscopy, gonioscopy, tonometry, ophtalmoscopy examination as well as visual acuty test. We have also used the statistcal ophtalmoscopy examination as well as visual acuty test. We have also used the statistcal methods of the processing and analyzis according to the protocol of the WHO. methods of the processing and analyzis according to the protocol of the WHO.

• Results and discussion: Results and discussion: The mean age of the patients with the changes in the ICA was The mean age of the patients with the changes in the ICA was 61.1 years and varied from 17-77 years. Our study found that most affected age was 61.1 years and varied from 17-77 years. Our study found that most affected age was from 60-69 years.from 60-69 years.

At the ICA, we have clasified four stages from I till IV and ascertained that there is a high At the ICA, we have clasified four stages from I till IV and ascertained that there is a high and positive corelation between stage of the ICA and IOP which was varied from 25 and positive corelation between stage of the ICA and IOP which was varied from 25 mmHg till 59 mmHg. Reuslts of the IOP, have also determined the ocular clinical state of mmHg till 59 mmHg. Reuslts of the IOP, have also determined the ocular clinical state of compensation, subcompensation and decompensation. Visual acuity damages at the compensation, subcompensation and decompensation. Visual acuity damages at the NVG, have been clasified as the big damages with 84.7% of cases and minor damages NVG, have been clasified as the big damages with 84.7% of cases and minor damages with 15.3% of cases. Cases with the heavy damages were the cases with blindness, L+P± with 15.3% of cases. Cases with the heavy damages were the cases with blindness, L+P± up to V=0.3 and cases with slightly damages with V=0.4-1.0. Visual acuity damages up to V=0.3 and cases with slightly damages with V=0.4-1.0. Visual acuity damages were in corelation with the changes in the PNO from initial stage to absolute stage. were in corelation with the changes in the PNO from initial stage to absolute stage.

• Conclusion: Conclusion: All necessary measurements should be taken in order to prevent All necessary measurements should be taken in order to prevent neovascular appearence, spread and development in the ICA of etiology whatever, neovascular appearence, spread and development in the ICA of etiology whatever, because such a monitoring will enable us to prevent the elevation of the IOP with direct because such a monitoring will enable us to prevent the elevation of the IOP with direct influence at PNO and visual acuity and to be successfully in managing of the NVG which, influence at PNO and visual acuity and to be successfully in managing of the NVG which, otherwise will be with irreversible and heavy consequences. otherwise will be with irreversible and heavy consequences. 18.06.2010 23

• GLAUCOMA SESSION •Presidency: Mustafa Sefic, Slobodanka Latinovic & Ilhami Presidency: Mustafa Sefic, Slobodanka Latinovic & Ilhami

GoranciGoranci

THANK YOU.., Ju faleminderit..,

Correlation of the changes between the Correlation of the changes between the iridocorneal angle and otheriridocorneal angle and other

parameters at the neovascular glaucomaparameters at the neovascular glaucoma

NEOVASCULAR GLAUCOMA STUDY

NVG*****GNVNVG*****GNV

Authors: Authors:

Mr.sci.dr.Halil Z. AJVAZI, Prof.dr.Ilhami GORANCI, Mr.sci.dr.Halil Z. AJVAZI, Prof.dr.Ilhami GORANCI, Dr.spec.Ardiana GORANCI, Dr.spec.Dafina GORANCI,Dr.spec.Ardiana GORANCI, Dr.spec.Dafina GORANCI, Dr.spec.Bekim KASTRATI, Dr.Ass.Mimoza ISMAILI.Dr.spec.Bekim KASTRATI, Dr.Ass.Mimoza ISMAILI.

Sincerely yours .., FACULTY OF MEDICINE,

UNIVERSITETY IN PRISHTINA - KOSOVO

TIRANA / JUNY / 2010. UCC-CLINIC OF OPHTALMOLOGY UCC-CLINIC OF OPHTALMOLOGY

E-mail:dr.ajvazi @ yahoo.comE-mail:dr.ajvazi @ yahoo.com

77 thth Congress Congress of of SouthSouth -- East East European European

Ophthalmological Ophthalmological Society Society - - SEEOSSEEOS

TIRANA – 2010 TIRANA – 2010 Halil Ajvazi, Ilhami Goranci, Ardiana Goranci, Dafina Halil Ajvazi, Ilhami Goranci, Ardiana Goranci, Dafina

Goranci,Goranci,Bekim Kastrati, Mimoza Ismaili. Bekim Kastrati, Mimoza Ismaili.

18.06.2010 24

77 thth Congress Congress of of SouthSouth -- East East European European Ophthalmological Ophthalmological

Society Society - - SEEOSSEEOS TIRANA – 2010 TIRANA – 2010

18.06.201025