PRACTICAL APPROACH TO MEDICAL MANAGEMENT OF GLAUCOMA青光眼药物治疗的实用方法.pptVIP

PRACTICAL APPROACH TO MEDICAL MANAGEMENT OF GLAUCOMA DR. RAVI THOMAS, DR. RAJUL PARIKH, DR. SHEFALI PARIKH IJO MAY 2008 PRESENTER AT JDOS : DR. RAHUL SHUKLA T.N. SHUKLA EYE HOSPITAL TERMINOLOGY POAG: PRIMARY OPEN ANGLE GLAUCOMA NTG: NORMAL TENSION GLAUCOMA OH: OCULAR HYPERTENSION PRE PERIMETRIC GLAUCOMA TARGET IOP POAG : PRIMARY OPEN ANGLE GLAUCOMA Chronic progressive optic neuropathy. Characteristic optic disc changes. Corresponding visual field defects. IOP only treatable factor. It’s a diagnosis of exclusion. NTG: NORMAL TENSION GLAUCOMA Same as POAG Except that - CCT corrected IOP is less than 22 mmhg applanation on dirurnal variation. PREPERIMETRIC GLAUCOMA Disc changes (cupping) present. Nerve fiber layer (NFL) changes present. No defect on white on white perimetry. BASIC PRINCIPLES Establish a diagnosis. Establish a baseline IOP. Set a target IOP. Initiate therapy to lower IOP to target. Follow up. ESTABLISH A DIAGNOSIS CEE Comprehensive Eye Examination No substitute to CEE CEE comprises of - Slit lamp biomicroscopy - Goldman applanation tonometry - Gonioscopy, preferably indentation dynamic - Indirect ophthalmoscopy - Stereoscopic examination of optic disc NFL APPLANATION TONOMETRY Single reading not reliable, poor sensitivity specificity. Repeat IOP. Diurnal variation. Goldman / Perkins are standard. Schoitz outdated, very limited role in modern glaucoma management. GONIOSCOPY Diagnosis of POAG is by exclusion. Indentation gonioscopy more useful. Dynamic procedure should be repeated Rule out - Narrow angle - Closure - Secondary glaucoma OPTIC DISC RNFL ANALYSIS Best by 60 D or 90 D lens (stereo biomicroscopy). Red free illumination for Retinal Nerve Fiber Layer. Stereo photographs of optic disc are gold standard. IMAGING TECHNIQUES AIGS (Association of International Glaucoma Societies) does not support the use of HRT - HEIDELBERG RETINAL TOMOGRAPHY GDX VCC - SCANNING LASER POLARIMETRY OCT - OPTICAL COHORENCE TOMOGRAPHY for all pa