Gonioscopy-hubli课件.pptVIP

Gonioscopy  Dr.Gowri J Murthy, Glaucoma Service, Vittala International Institute of Ophthalmology, Prabha Eye Clinic and Research Centre Bangalore. Gonioscopy Structure of answer Definition Principles Types Uses Grading systems Indications Advances Use line diagrams Flow charts Underline key points Angle Closure Glaucoma Major form of Glaucoma in our country Early detection is of paramount importance as Laser PI has potential to alter natural history. Anterior chamber angle assessment remains the key to manage this condition effectively. Anterior segment angle assessment. Gonioscopy- Remains the current reference standard. Subjective assessment Interobserver variability Different lenses used can alter angle appearance and affect interpretation. Objective Angle Assessment Ultrasound Biomicroscopy. AS OCT Scheimpflug photography Objective methods. Are yet to replace Gonioscopy for angle assessment. Definition: Gonioscopy is a clinical technique used to examine structures in the anterior chamber angle. Trantas, using limbal indentation in an eye with keratoglobus in 1907, first visualized the anterior chamber angle in a living eye and coined the term gonioscopy. INDIRECT Gonioscopy: The light rays are reflected by a mirror/ prism in the contact lens and leave the lens at nearly a right angle to the contact lens- air interface. Eg: Goldmann single, and three mirror lenses, Ziess four mirror lenses, posner and susmann four mirror lenses, Thorpe four mirror, Ritch trabeculoplasty lens Example open angle Limitations Definitions of occludable angle. “looking over the hill”/ Manipulations with gonioscopy. Dynamic procedure. Difficulty in documentation- good slit lamp gonio photographs are difficult to take. Quantification: Objective Gonioscopy * ? The normal angle of the eye is not visible to us due to total internal reflection of light emanating from the angle. ? ? DIRECT Gonioscopy: The anterior curve of the goniolens is such that the critical angle is n