Neovascular glaucoma

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  • Sudden blurring of vision of both eyes… the exact date not known. Basta the patient noted that he can still see properly during the barangay elections which was last week of October Worse at nightEye pain OSNo medications were taken No consult was done
  • Symptoms persisted which prompted consult in another institution where he was diagnosed to have mature cataract of both eyeHe was being worked up for hypertension and lab tests were requested but due to financial constraints, he was not able to do them
  • Few days after that consult the patient’s left eye became red and very painful. He can only perceive light. This prompted him to consult our institution for the first time
  • Few days after that consult the patient’s left eye became red and very painful. He can only perceive light. This prompted him to consult our institution for the first time
  • Asthma and/or COPD – limit the use of topical beta blockersSystemic hpn – systemic beta blocers may mask elevated IOPDiabetes – increasingly prevalent and associate with open angle and neovascular glaucomaUrinary stones – limit systemic carbonic anhydrase inhibitors
  • Asthma and/or COPD – limit the use of topical beta blockersSystemic hpn – systemic beta blocers may mask elevated IOPDiabetes – increasingly prevalent and associate with open angle and neovascular glaucomaUrinary stones – limit systemic carbonic anhydrase inhibitors
  • Asthma and/or COPD – limit the use of topical beta blockersSystemic hpn – systemic beta blocers may mask elevated IOPDiabetes – increasingly prevalent and associate with open angle and neovascular glaucomaUrinary stones – limit systemic carbonic anhydrase inhibitors
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  • Aqueous humour is secreted into the posterior chamber by the ciliary body, specifically the non-pigmented epithelium of the ciliary body(pars plicata). It flows through the narrow cleft between the front of the lens and the back of the iris, to escape through the pupil into the anterior chamber, and then to drain out of the eye via the trabecular meshwork. From here, it drains into Schlemm's canal by one of two ways: directly, via aqueous vein to the episcleral vein, or indirectly, via collector channels to the episcleral vein by intrascleral plexus and eventually into the veins of the orbit.[edit]
  • almost always ischemic in nature. Under hypoxic conditions, diffusible angiogenic factors, including vascular endothelial growth factor, have been detected in the human and animal retina and vitreous, promoting new vessel growth. Clinically, the three most common conditions responsible for NVG are diabetic retinopathy, central retinal vein occlusion and carotid artery obstructive disease.Anterior segment neovascularization involving the iris, the angle or both is accompanied by the formation of a fibrovascular membrane that is seen histologically.
  • This membrane initially obstructs the aqueous outflow through the trabecular meshwork and results in open-angle glaucoma, which may be amenable to pharmacological management of the elevated IOP as the disease progresses, the proliferating myofibroblasts of the fibrovascular membrane contract, leading to ectropionuveae, peripheral anterior synechiae and, ultimately, total synechial angle closure. This stage is not reversible by PRP. The resultant secondary glaucoma is often refractory to pharmacological management and requires surgical intervention.
  • three most common conditions responsible for NVG are diabetic retinopathy, central retinal vein occlusion and carotid artery obstructive disease.
  • Intravenous fluorescein angiogram and electroretinography (ERG) to assess retinal ischemiaB-scan ultrasoundOptical coherence tomography2- Images observed per grade of neovascular glaucomaGrade 1: No modificationGrade 2: A slightly hyper-reflective linear iris secondary to neovascularizationGrade 3: A thickened hyper-reflective iridocorneal angle with possible iridocorneal synechiaeGrade 4: Closed iridocorneal angle associated with iris contraction and uveae ectropion
  • CHANGE TITLE
  • Neovascular glaucoma

    1. 1. Ophtha Case Presentation<br />By: Cristal Ann G. Laquindanum<br /> Year Level 8 <br />Ateneo School of Medicine and Public Health<br />
    2. 2. Identifying data<br />VR, 59 yr old male<br />Blurring of vision, OU<br />Informant reliability: 80%<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    3. 3. History of Present Illness<br />VR, 59 yr male<br />Chief complaint: blurring of vision, OU<br />1 month PTC<br /><ul><li>Sudden blurring of vision, OU
    4. 4. Worse at night
    5. 5. With an associated eye pain, OS</li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    6. 6. History of Present Illness<br />VR, 59 yr male<br />Chief complaint: blurring of vision, OU<br />1 month PTC<br /><ul><li>Sudden blurring of vision, OU
    7. 7. Worse at night
    8. 8. With an associated eye pain, OS</li></ul>2 weeks PTC<br /><ul><li>Diagnosed to have mature cataract, OU in another institution
    9. 9. Financial constraints prevented him to have lab tests done
    10. 10. Given anti-hypertensive meds</li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    11. 11. History of Present Illness<br />VR, 59 yr male<br />Chief complaint: blurring of vision, OU<br />1 month PTC<br /><ul><li>Sudden blurring of vision, OU
    12. 12. Worse at night
    13. 13. With an associated eye pain, OS</li></ul>2 weeks PTC<br /><ul><li>Diagnosed to have mature cataract, OU in another institution
    14. 14. Financial constraints prevented him to have lab tests done
    15. 15. Anti-hypertensive drugs given</li></ul>1 week PTC<br /><ul><li>Patient’s left eye became red and painful until vision was only light perception</li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    16. 16. History of Present Illness<br />VR, 59 yr male<br />Chief complaint: blurring of vision, OU<br />1 month PTC<br /><ul><li>Sudden blurring of vision, OU
    17. 17. Worse at night
    18. 18. With an associated eye pain, OS</li></ul>2 weeks PTC<br /><ul><li>Diagnosed to have mature cataract, OU in another institution
    19. 19. Financial constraints prevented him to have lab tests done
    20. 20. Anti-hypertensive drugs given</li></ul>1 week PTC<br /><ul><li>Patient’s left eye became red and painful until vision was only light perception</li></ul>2 days PTC<br /><ul><li>Consult at this institution
    21. 21. T/C ARMD, OD and Narrow angle glaucoma, OS
    22. 22. Given Acetazolamide250 mg 2 tabs then TID for 3 days</li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    23. 23. Review of Systems<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS <br />No history of trauma<br />No weight loss<br />No cough and cold<br />No rashes<br />No changes in hair/nails<br />No changes in color<br />No tinnitus<br />No nosebleeds<br />No hemoptysis<br />No chest pain<br />No syncope<br />No changes in bowel habits<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    24. 24. Past Medical History<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS <br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />No known history of asthma and/or COPD<br />No known history of diabetes<br />No known history of urinary stones<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    25. 25. Past Medical History<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma <br />Medications:<br />Losartan and Betahistine<br />Acetazolamide 250 mg 2 tab, then 3x/day for 3 days<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    26. 26. Family History<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma <br />Paternal history of Pulmonary tuberculosis<br />Maternal history of Diabetes mellitus<br />Maternal history of Hypertension<br />No known family history of the following: <br /> - cancer<br /> - stroke<br /> - asthma<br /> - allergies<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    27. 27. Personal and Social History<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension <br />Inactive carpenter<br />43 pack year smoker<br />Non-alcohol beverage drinker<br />Lives with his wife <br />Has four children with families of their own<br />Poor health-seeking behavior<br />Financial constraints<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    28. 28. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension <br />Awake, ambulatory, <br />not in cardiorespiratory distress<br />BP: 160/80 (hypertensive)<br />HR: 75(normal)<br />RR: 20 (normal) <br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    29. 29. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />HENNT<br />No TPC, No CLAD<br />Neck veins not dilated<br />Intact tympanic membrane<br />Midline septum, no discharge<br />No neck rigidity<br />Dry lips, moist buccal mucosa<br />Nonhyperemic pharynx<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    30. 30. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Chest/Lungs<br />Symmetrical chest expansion<br />Resonant on percussion<br />Equal tactile and vocal fremiti<br />No retractions<br />No rales<br />No wheezes<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    31. 31. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Heart<br />Adynamicprecordium<br />No heaves or thrills<br />Apex beat is at 5th ICS MCL<br />Normal rate, regular rhythm<br />No murmurs<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    32. 32. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Abdomen<br />Flat, soft abdomen<br />No tenderness<br />No organomegaly<br />No masses<br />Normoactive bowel sounds<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    33. 33. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Extremities<br />Full pulses<br />No edema, no cyanosis<br />Good turgor<br />No rashes, no lesions<br />Equally distributed hair<br />No clubbing<br />CRT <2sec <br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    34. 34. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Neuro<br />Awake, cooperative, coherent<br />Motor: 5/5 on all extremities<br />Sensory: 100% on all extremities<br />Gait: normal, very slow <br />GCS 15<br />Cranial Nerves: intact<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    35. 35. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Ophthalmologic<br />Visual Acuity<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    36. 36. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS <br />Ophthalmologic<br />Gross Examination<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    37. 37. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS<br />mid-dilated, poorly reactive, OS <br />Ophthalmologic<br />Gross Examination<br />OS<br />OD<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    38. 38. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS<br />mid-dilated, poorly reactive, OS <br />Ophthalmologic<br />Extra-ocular Movements<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    39. 39. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS<br />mid-dilated, poorly reactive, OS <br />Ophthalmologic<br />Tonometry<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    40. 40. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS<br />Mid-dilated, poorly reactive, OS <br />Increased IOP, OS <br />Ophthalmologic<br />Fundoscopy<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    41. 41. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS<br />Mid-dilated, poorly reactive, OS <br />Increased IOP, OS <br />Ophthalmologic<br />Neovascularization, OS<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    42. 42. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS<br />Mid-dilated, poorly reactive, OS <br />Increased IOP, OS <br />Iris neovascularization, OS <br />Ophthalmologic<br />Optic nerve<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    43. 43. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive<br />Light perception, OS<br />Mid-dilated, poorly reactive, OS <br />Increased IOP, OS <br />Iris neovascularization, OS <br />Ophthalmologic<br />Peripheral anterior synechiae with trabecular meshwork seen<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    44. 44. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Light perception, OS<br />Mid-dilated, poorly reactive, OS <br />Increased IOP, OS <br />Iris neovascularization, OS <br />Ophthalmologic<br />Closed angle<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    45. 45. Physical Examination<br />VR, 59 yr male<br />CC: blurring of vision, OU<br />Eye pain, OS<br />Diagnosed with cataract, OU<br />T/C ARMD, OD<br />T/C Narrow angle glaucoma, OS<br />Unknown history of hypertension<br />2 months PTC, patient had right sided weakness <br />No history of ocular trauma<br />Family history of PTB, DM, hypertension<br />Hypertensive <br />Light perception, OS<br />Mid-dilated, poorly reactive, OS <br />Increased IOP, OS <br />Iris neovascularization, OS <br />Ophthalmologic<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    46. 46. Salient Features<br /><ul><li>59 year old male
    47. 47. CC: blurring of vision, OU
    48. 48. Eye pain, OS
    49. 49. Unknown history of hypertension
    50. 50. 2 months PTC, patient had right sided weakness
    51. 51. No history of ocular trauma
    52. 52. Family history of PTB, DM, hypertension
    53. 53. Hypertensive
    54. 54. Light perception, OS
    55. 55. Mid-dilated, poorly reactive, OS
    56. 56. Increased IOP, OS
    57. 57. Iris neovascularization, OS </li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    58. 58. Salient Features<br />Neovascular Glaucoma<br /><ul><li>59 year old male
    59. 59. CC: blurring of vision, OU
    60. 60. Eye pain, OS
    61. 61. Unknown history of hypertension
    62. 62. 2 months PTC, patient had right sided weakness
    63. 63. No history of ocular trauma
    64. 64. Family history of PTB, DM, hypertension
    65. 65. Hypertensive
    66. 66. Light perception, OS
    67. 67. Mid-dilated, poorly reactive, OS
    68. 68. Increased IOP, OS
    69. 69. Iris neovascularization, OS </li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    70. 70. Differential Diagnosis<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    71. 71. At the OPD<br />Brimonidinetartrate<br />Possible valve implant, OS<br />Anti-VEGF injection, OS<br />CP clearance <br />Hypertension work-up (IM referral)<br />HPN Stage II<br />BP Monitoring for two weeks<br />Captopril 25 mg ½ tab OD<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    72. 72. Signs and Symptoms<br /><ul><li>classified as a secondary glaucoma
    73. 73. historically, it has been referred to as hemorrhagic glaucoma, thrombotic glaucoma, congestive glaucoma, rubeotic glaucoma, and diabetic hemorrhagic glaucoma
    74. 74. secondary ocular and systemic diseases that share one common element, retinal ischemia/hypoxia and subsequent release of an angiogenesis factor</li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    75. 75. Pathophysiology<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    76. 76. Pathophysiology<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    77. 77. Pathophysiology<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    78. 78. Pathophysiology<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    79. 79. Diagnostics<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    80. 80. Treatment<br />Goals of treatment<br /><ul><li>reducing elevated IOP
    81. 81. treating the underlying disease that led to the ischemic insult </li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    82. 82. Treatment<br /><ul><li>Panretinal photocoagulation
    83. 83. Medical treatment
    84. 84. Anti-VEGF therapy
    85. 85. Surgical intervention</li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    86. 86. Treatment<br />OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    87. 87. Treatment<br /><ul><li>Surgical intervention
    88. 88. Valve implant
    89. 89. Trabeculectomy</li></ul>OphthaCase Presentation <br />By: Cristal Ann G. Laquindanum<br /> Year Level 8, Ateneo School of Medicine and Public Health<br />
    90. 90. Ophtha Case Presentation<br />By: Cristal Ann G. Laquindanum<br /> Year Level 8 <br />Ateneo School of Medicine and Public Health<br />

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