This document discusses various aspects of glaucoma including:
1. It provides prevalence rates for primary open-angle glaucoma (POAG) among different racial groups based on a study. The prevalence was highest among Black individuals.
2. The prevalence of primary angle-closure glaucoma (PACG) also varies significantly among racial/ethnic groups and is highest in Inuit populations in Alaska and Greenland.
3. Ocular hypertension is defined as elevated intraocular pressure without signs of glaucoma and many such patients do not develop the disease.
4. Glaucoma results from the slow degeneration of retinal ganglion cells and their axons due to various mechanisms like
Cscr ( central serous chorioretinopathy )Vinitkumar MJ
Central serous chorioretinopathy (CSCR) is characterized by spontaneous serous detachment of the neurosensory retina in the macular region. It typically affects young to middle-aged males and is associated with type A personality and steroid use. The leading pathogenesis theory is choroidal vascular hyperpermeability causing a breach in the outer blood-retinal barrier and leakage of fluid. On examination, CSCR presents as mild macular elevation with or without retinal pigment epithelium detachment. It usually resolves spontaneously but can recur in 30-50% of cases.
Cystoid macular edema (CME) refers to fluid collection in the macula and is a complication of ocular surgery,
This document discusses intermediate uveitis (IU), which involves inflammation in the anterior vitreous, pars plana, and peripheral retina. IU accounts for 8-22% of uveitis cases. Clinically, it is characterized by "snowballs" or yellow-white exudates in the peripheral vitreous. Treatment involves topical/periocular steroids initially, with cryotherapy, vitrectomy or immunosuppressants for non-responsive cases. Complications include cystoid macular edema, cataracts, glaucoma, and retinal detachment. Proper diagnosis requires excluding other causes like syphilis, Lyme disease, multiple sclerosis and sarcoidosis.
This document provides information on evaluating and diagnosing a case of primary open-angle glaucoma (POAG). It discusses the epidemiology and risk factors of POAG such as increased age, family history, and elevated intraocular pressure. The examination involves assessing visual acuity, optic nerve head changes through fundus evaluation and imaging, visual field testing, intraocular pressure measurement, and gonioscopy to evaluate the anterior chamber angle. Diagnosis is based on characteristic optic nerve damage and visual field loss in the setting of an open anterior chamber angle and absence of other causes. Management involves long-term monitoring and treatment to lower intraocular pressure through medication or surgery as needed.
Cavernous sinus thrombosis (CST) is a rare, life-threatening disorder that can complicate facial infection, sinusitis, orbital cellulitis, pharyngitis, or otitis or following traumatic injury or surgery, especially in the setting of a thrombophilic disorder. Early recognition of cavernous sinus thrombosis which, often presents with fever, headache, eye findings such as periorbital swelling, and ophthalmoplegia, is critical for a good outcome. Despite modern treatment with antibiotics and anticoagulation, the risk of long-term sequelae, such as vision, diplopia, and stroke, remains significant. This activity examines when cavernous sinus thrombosis should be considered, how to properly evaluate this condition and the role of the interprofessional team in caring for patients with this condition.
Pars Planitis is a disease of the eye that is characterized by inflammation of the narrowed area (pars plana) between the colored part of the eye (iris) and the choroid. This may lead to blurred vision; dark, floating spots in the vision; and progressive vision loss.
Sarcoidosis is a chronic multisystem inflammatory disorder characterized by non-caseating granulomas in affected tissues. Common organs involved are the lungs, lymph nodes, eyes, skin and heart. Ocular involvement occurs in 40% of sarcoidosis patients, most commonly presenting as uveitis. Uveitis manifestations include anterior uveitis, intermediate uveitis, posterior uveitis, scleritis, conjunctivitis, keratopathy and optic nerve involvement. Treatment involves topical, periocular or intraocular corticosteroids. Systemic corticosteroids or immunosuppressive drugs are used for more severe or treatment resistant disease.
Glaucoma is not a single disease process but a group of disorders characterized by a progressive optic neuropathy resulting in a irreversible visual field defects that are associated frequently raised intraocular pressure (IOP).
IOP is the most common risk factor but not the only risk factor for development of glaucoma.
This document summarizes various types of orbital inflammation including preseptal cellulitis, orbital cellulitis, idiopathic orbital inflammatory disease, orbital myositis, dacryoadenitis, thyroid orbitopathy, Tolosa-Hunt syndrome, and rhino-orbital mucormycosis. It describes the presentations, risk factors, pathogenesis, diagnostic evaluations, and treatment approaches for each condition. The document emphasizes that orbital inflammatory diseases encompass a broad spectrum and can affect people of all ages, with varying degrees of visual impairment, proptosis, ophthalmoplegia, and pain depending on the specific condition and extent of inflammation present.
Cscr ( central serous chorioretinopathy )Vinitkumar MJ
Central serous chorioretinopathy (CSCR) is characterized by spontaneous serous detachment of the neurosensory retina in the macular region. It typically affects young to middle-aged males and is associated with type A personality and steroid use. The leading pathogenesis theory is choroidal vascular hyperpermeability causing a breach in the outer blood-retinal barrier and leakage of fluid. On examination, CSCR presents as mild macular elevation with or without retinal pigment epithelium detachment. It usually resolves spontaneously but can recur in 30-50% of cases.
Cystoid macular edema (CME) refers to fluid collection in the macula and is a complication of ocular surgery,
This document discusses intermediate uveitis (IU), which involves inflammation in the anterior vitreous, pars plana, and peripheral retina. IU accounts for 8-22% of uveitis cases. Clinically, it is characterized by "snowballs" or yellow-white exudates in the peripheral vitreous. Treatment involves topical/periocular steroids initially, with cryotherapy, vitrectomy or immunosuppressants for non-responsive cases. Complications include cystoid macular edema, cataracts, glaucoma, and retinal detachment. Proper diagnosis requires excluding other causes like syphilis, Lyme disease, multiple sclerosis and sarcoidosis.
This document provides information on evaluating and diagnosing a case of primary open-angle glaucoma (POAG). It discusses the epidemiology and risk factors of POAG such as increased age, family history, and elevated intraocular pressure. The examination involves assessing visual acuity, optic nerve head changes through fundus evaluation and imaging, visual field testing, intraocular pressure measurement, and gonioscopy to evaluate the anterior chamber angle. Diagnosis is based on characteristic optic nerve damage and visual field loss in the setting of an open anterior chamber angle and absence of other causes. Management involves long-term monitoring and treatment to lower intraocular pressure through medication or surgery as needed.
Cavernous sinus thrombosis (CST) is a rare, life-threatening disorder that can complicate facial infection, sinusitis, orbital cellulitis, pharyngitis, or otitis or following traumatic injury or surgery, especially in the setting of a thrombophilic disorder. Early recognition of cavernous sinus thrombosis which, often presents with fever, headache, eye findings such as periorbital swelling, and ophthalmoplegia, is critical for a good outcome. Despite modern treatment with antibiotics and anticoagulation, the risk of long-term sequelae, such as vision, diplopia, and stroke, remains significant. This activity examines when cavernous sinus thrombosis should be considered, how to properly evaluate this condition and the role of the interprofessional team in caring for patients with this condition.
Pars Planitis is a disease of the eye that is characterized by inflammation of the narrowed area (pars plana) between the colored part of the eye (iris) and the choroid. This may lead to blurred vision; dark, floating spots in the vision; and progressive vision loss.
Sarcoidosis is a chronic multisystem inflammatory disorder characterized by non-caseating granulomas in affected tissues. Common organs involved are the lungs, lymph nodes, eyes, skin and heart. Ocular involvement occurs in 40% of sarcoidosis patients, most commonly presenting as uveitis. Uveitis manifestations include anterior uveitis, intermediate uveitis, posterior uveitis, scleritis, conjunctivitis, keratopathy and optic nerve involvement. Treatment involves topical, periocular or intraocular corticosteroids. Systemic corticosteroids or immunosuppressive drugs are used for more severe or treatment resistant disease.
Glaucoma is not a single disease process but a group of disorders characterized by a progressive optic neuropathy resulting in a irreversible visual field defects that are associated frequently raised intraocular pressure (IOP).
IOP is the most common risk factor but not the only risk factor for development of glaucoma.
This document summarizes various types of orbital inflammation including preseptal cellulitis, orbital cellulitis, idiopathic orbital inflammatory disease, orbital myositis, dacryoadenitis, thyroid orbitopathy, Tolosa-Hunt syndrome, and rhino-orbital mucormycosis. It describes the presentations, risk factors, pathogenesis, diagnostic evaluations, and treatment approaches for each condition. The document emphasizes that orbital inflammatory diseases encompass a broad spectrum and can affect people of all ages, with varying degrees of visual impairment, proptosis, ophthalmoplegia, and pain depending on the specific condition and extent of inflammation present.
The document summarizes the anatomy and physiology of the anterior angle of the eye. It describes the trabecular meshwork and Schlemm's canal, which allow aqueous humour to drain from the eye. It also discusses the non-conventional outflow pathway and the role of the ciliary body. The document then covers aqueous production mechanisms, ocular hypertension, evaluation of the anterior chamber angle using gonioscopy, optic nerve head anatomy, diagnosing glaucoma, primary open-angle glaucoma risk factors and signs.
A complete unit of the various diseases involving the orbit and the surrounding structures. It involves the unilateral and bilateral proptosis conditions. Also, the various proptosis etiologies involved in adults and children along with various tumors involving the orbit is also dealt with.
Toxoplasmosis is caused by the protozoan Toxoplasma gondii. It commonly infects intermediate hosts such as humans through contact with cat feces or consumption of undercooked meat containing cysts. In the eye, it most often causes retinochoroiditis which can lead to vision loss. Diagnosis is usually based on clinical findings, though serology and imaging tests provide supporting evidence. Treatment involves anti-protozoal medications such as sulfadiazine combined with pyrimethamine and corticosteroids to reduce inflammation. Recurrences are common in immunocompromised patients.
This document provides an overview of the approach to glaucoma, including its classification, clinical evaluation, investigations, and principles of management. It begins by defining glaucoma and describing its causes. Clinical evaluation involves taking a thorough medical history and performing examinations of the eye, including visual acuity, visual fields, gonioscopy, and evaluation of the optic nerve head. Glaucoma is classified based on age of onset, etiology, and iridocorneal angle assessment. Proper clinical evaluation and classification are important for developing an appropriate management plan for glaucoma.
This document provides an overview of hematuria and glomerular causes of hematuria. It defines macroscopic and microscopic hematuria and discusses various glomerular diseases that can cause hematuria including IgA nephropathy, Alport syndrome, thin basement membrane disease, post-infectious glomerulonephritis, and Henoch–Schönlein purpura. It describes the clinical presentations, pathologies, diagnoses, and treatments of these conditions. Key investigations for glomerular hematuria are outlined.
Eale’s disease is an idiopathic inflammation of the peripheral retinal veins that causes recurrent vitreous hemorrhage. It typically affects young adult males and is characterized by sudden floaters or vision loss due to bleeding in the vitreous. Treatment includes corticosteroids, laser photocoagulation, and vitreoretinal surgery for complications like retinal detachment. Optic neuritis refers to inflammatory disorders of the optic nerve with possible causes including multiple sclerosis, infections, and autoimmune diseases. Symptoms include sudden monocular vision loss and pain with eye movements. Signs include reduced visual acuity and a relative afferent pupillary defect.
This document discusses Thyroid Eye Disease (TED), a common orbital disorder associated with thyroid dysfunction. It covers the epidemiology, pathology, clinical features, evaluation, and management of TED. Some key points:
- TED is an autoimmune condition causing inflammation and swelling of extraocular muscles and orbital tissues. It is seen in Graves' disease and Hashimoto's thyroiditis.
- Symptoms include eye irritation, bulging eyes (proptosis), and impaired eye movement. Signs include eyelid retraction, proptosis, and restrictive extraocular muscle involvement.
- Evaluation involves assessing thyroid function and signs of orbital involvement. Severity is classified using Werner's or EUGO
Retinal vasculitis is an inflammatory eye disease involving the retinal vessels that can occur due to infectious, neoplastic, or systemic inflammatory disorders. It is detected clinically using fundus fluorescein angiography. It can lead to leakage and exudation from affected vessels, as well as occlusion causing cotton-wool spots, edema, hemorrhages, and retinal infarction. Late sequelae include vitreous hemorrhage, tractional retinal detachment, neovascular glaucoma, and rubeosis iridis. Retinopathy of prematurity is a disease affecting the retinas of premature infants that ranges from mild cases to severe cases causing bilateral blindness. It results from an initial vasocon
Glaucoma is a group of eye diseases characterized by optic nerve damage and visual field loss. It is often associated with elevated intraocular pressure but can sometimes occur with normal pressures. The two main types are open-angle glaucoma and angle-closure glaucoma. Congenital glaucoma is present at birth and results from impaired aqueous outflow, often due to developmental abnormalities in the trabecular meshwork. It is typically treated surgically through procedures like goniotomy or trabeculotomy to improve drainage and lower pressure. Long term monitoring is important as the disease can progress if not properly managed.
This document provides information about fluorescein angiography and indocyanine green angiography. It discusses the basic principles of angiography including fluorescence and luminescence. It describes the chemical, optical, and pharmacological properties of fluorescein sodium used in fluorescein angiography. The normal phases and findings of a fluorescein angiogram are outlined. Common abnormalities detected on fluorescein angiography such as leakage and blockage are also summarized. The document concludes by discussing indocyanine green angiography which allows better visualization of the choroidal circulation compared to fluorescein angiography.
This document provides information about fluorescein angiography and indocyanine green angiography. It discusses the basic principles of angiography including fluorescence and absorption of light. It describes the properties and pharmacokinetics of fluorescein and the phases and findings of a normal fluorescein angiogram. It also discusses patient preparation, contraindications, common abnormalities seen on angiography and how various retinal conditions present on angiography. Finally, it provides an overview of indocyanine green angiography including its principles and advantages over fluorescein angiography.
- Orbital cellulitis is a serious infection of the orbital tissues that does not involve the globe itself. It is most commonly caused by bacterial infection spreading from the paranasal sinuses.
- Physical examination includes assessing vision, eye movements, proptosis, pupil function, and examining the orbit, eyelids and anterior/posterior segments for signs of infection or complications.
- Early diagnosis and treatment with intravenous antibiotics is important to prevent vision loss or life-threatening intracranial infections.
Ocular toxoplasmosis is caused by the protozoan Toxoplasma gondii and is the leading cause of posterior uveitis worldwide. It presents as recurrent inflammation and damage to the retina and choroid that can cause visual impairment. While most infections are asymptomatic, some may experience vision loss due to complications like macular scarring. Diagnosis involves antibody tests and imaging, while treatment focuses on antibiotics, though none can eliminate the parasite permanently.
Leukocoria ( or white pupillary reflex) is an abnormal white reflection from the eye.
Leukocoria is a medical sign for a number of several conditions.
- this presentation at annual conference of the Ophthalmic department, faculty of medicine - Al-Azhar University in association with DOS & EOS Cairo, Egypt January 2017
This document summarizes key information about pyogenic brain abscesses:
- They are focal collections of pus within the brain, most commonly caused by contiguous infections from the ear, sinuses, or mouth spreading via veins.
- Symptoms vary depending on size and location but often include headache, fever, and neurological deficits. Diagnosis involves CT or MRI imaging and treatment involves antibiotics plus surgical drainage for larger abscesses.
Intermediate uveitis is a form of uveitis that causes inflammation in the vitreous humor and peripheral retina. It most commonly affects children and young adults. Symptoms include blurred vision and floaters. If left untreated, it can cause complications like cystoid macular edema, epiretinal membranes, and cataract formation that lead to vision loss. Treatment involves corticosteroids administered topically, periocularly, or systemically. For cases that are resistant to steroids, immunosuppressive therapies may be used. With treatment, most patients have a generally good long-term prognosis with vision of 20/30 or better.
This document summarizes retinal artery occlusion, including classifications, epidemiology, clinical features, risk factors, evaluation, treatment, and prognosis for different types. Central retinal artery occlusion typically causes sudden, painless vision loss and has a poor visual prognosis. Branch retinal artery occlusion often causes partial vision loss and has a better prognosis, with vision recovering to 20/40 or better in most cases. Cilioretinal artery occlusion can occur in isolation or with central retinal vein occlusion, and isolated cases typically have a good visual outcome.
Evaluation of White Pupillary Reflex FINAL.pptxMahfuz Shohag
Leukocoria or white pupillary reflex can be caused by several conditions. The differential diagnosis can be narrowed through history, examination, and investigations. The main differentials discussed were congenital cataract, retinoblastoma, persistent hyperplastic primary vitreous, ocular toxocariasis, Coat's disease, retinopathy of prematurity, and coloboma. Early diagnosis is important as treatment can help save vision for many of these conditions causing leukocoria.
This document discusses intermediate uveitis, including its definition, causes, symptoms, signs, diagnosis, and treatment. Intermediate uveitis involves inflammation in the vitreous, pars plana region, and ora serrata region of the retina. Common causes include multiple sclerosis, Lyme disease, sarcoidosis, and various infections. Symptoms are often floaters and blurred vision. Signs include vitreous cells and snowbank formations in the inferior vitreous. Treatment involves topical or injected steroids, with immunosuppressants used for non-responsive cases.
case report.This is a 60 years old female patient, a known Glaucoma patient:pptxfajrimohammed
The document discusses various causes of unilateral acute granulomatous anterior uvitis with high intraocular pressure (IOP). It describes conditions like glaucomatocyclitic crisis, Fuchs heterochromic iridocyclitis, herpes zoster or simplex-associated uveitis, phacolytic and phacoantigenic glaucoma, and ciliary body inflammation and rotation with angle closure glaucoma that can lead to these symptoms. It also discusses evaluating and managing patients with uveitis and elevated pressure, including recognizing underlying syndromes, controlling IOP and inflammation, and addressing specific conditions like Fuchs heterochromic iridocyclitis and herpetic uveitis.
The document summarizes the anatomy and physiology of the anterior angle of the eye. It describes the trabecular meshwork and Schlemm's canal, which allow aqueous humour to drain from the eye. It also discusses the non-conventional outflow pathway and the role of the ciliary body. The document then covers aqueous production mechanisms, ocular hypertension, evaluation of the anterior chamber angle using gonioscopy, optic nerve head anatomy, diagnosing glaucoma, primary open-angle glaucoma risk factors and signs.
A complete unit of the various diseases involving the orbit and the surrounding structures. It involves the unilateral and bilateral proptosis conditions. Also, the various proptosis etiologies involved in adults and children along with various tumors involving the orbit is also dealt with.
Toxoplasmosis is caused by the protozoan Toxoplasma gondii. It commonly infects intermediate hosts such as humans through contact with cat feces or consumption of undercooked meat containing cysts. In the eye, it most often causes retinochoroiditis which can lead to vision loss. Diagnosis is usually based on clinical findings, though serology and imaging tests provide supporting evidence. Treatment involves anti-protozoal medications such as sulfadiazine combined with pyrimethamine and corticosteroids to reduce inflammation. Recurrences are common in immunocompromised patients.
This document provides an overview of the approach to glaucoma, including its classification, clinical evaluation, investigations, and principles of management. It begins by defining glaucoma and describing its causes. Clinical evaluation involves taking a thorough medical history and performing examinations of the eye, including visual acuity, visual fields, gonioscopy, and evaluation of the optic nerve head. Glaucoma is classified based on age of onset, etiology, and iridocorneal angle assessment. Proper clinical evaluation and classification are important for developing an appropriate management plan for glaucoma.
This document provides an overview of hematuria and glomerular causes of hematuria. It defines macroscopic and microscopic hematuria and discusses various glomerular diseases that can cause hematuria including IgA nephropathy, Alport syndrome, thin basement membrane disease, post-infectious glomerulonephritis, and Henoch–Schönlein purpura. It describes the clinical presentations, pathologies, diagnoses, and treatments of these conditions. Key investigations for glomerular hematuria are outlined.
Eale’s disease is an idiopathic inflammation of the peripheral retinal veins that causes recurrent vitreous hemorrhage. It typically affects young adult males and is characterized by sudden floaters or vision loss due to bleeding in the vitreous. Treatment includes corticosteroids, laser photocoagulation, and vitreoretinal surgery for complications like retinal detachment. Optic neuritis refers to inflammatory disorders of the optic nerve with possible causes including multiple sclerosis, infections, and autoimmune diseases. Symptoms include sudden monocular vision loss and pain with eye movements. Signs include reduced visual acuity and a relative afferent pupillary defect.
This document discusses Thyroid Eye Disease (TED), a common orbital disorder associated with thyroid dysfunction. It covers the epidemiology, pathology, clinical features, evaluation, and management of TED. Some key points:
- TED is an autoimmune condition causing inflammation and swelling of extraocular muscles and orbital tissues. It is seen in Graves' disease and Hashimoto's thyroiditis.
- Symptoms include eye irritation, bulging eyes (proptosis), and impaired eye movement. Signs include eyelid retraction, proptosis, and restrictive extraocular muscle involvement.
- Evaluation involves assessing thyroid function and signs of orbital involvement. Severity is classified using Werner's or EUGO
Retinal vasculitis is an inflammatory eye disease involving the retinal vessels that can occur due to infectious, neoplastic, or systemic inflammatory disorders. It is detected clinically using fundus fluorescein angiography. It can lead to leakage and exudation from affected vessels, as well as occlusion causing cotton-wool spots, edema, hemorrhages, and retinal infarction. Late sequelae include vitreous hemorrhage, tractional retinal detachment, neovascular glaucoma, and rubeosis iridis. Retinopathy of prematurity is a disease affecting the retinas of premature infants that ranges from mild cases to severe cases causing bilateral blindness. It results from an initial vasocon
Glaucoma is a group of eye diseases characterized by optic nerve damage and visual field loss. It is often associated with elevated intraocular pressure but can sometimes occur with normal pressures. The two main types are open-angle glaucoma and angle-closure glaucoma. Congenital glaucoma is present at birth and results from impaired aqueous outflow, often due to developmental abnormalities in the trabecular meshwork. It is typically treated surgically through procedures like goniotomy or trabeculotomy to improve drainage and lower pressure. Long term monitoring is important as the disease can progress if not properly managed.
This document provides information about fluorescein angiography and indocyanine green angiography. It discusses the basic principles of angiography including fluorescence and luminescence. It describes the chemical, optical, and pharmacological properties of fluorescein sodium used in fluorescein angiography. The normal phases and findings of a fluorescein angiogram are outlined. Common abnormalities detected on fluorescein angiography such as leakage and blockage are also summarized. The document concludes by discussing indocyanine green angiography which allows better visualization of the choroidal circulation compared to fluorescein angiography.
This document provides information about fluorescein angiography and indocyanine green angiography. It discusses the basic principles of angiography including fluorescence and absorption of light. It describes the properties and pharmacokinetics of fluorescein and the phases and findings of a normal fluorescein angiogram. It also discusses patient preparation, contraindications, common abnormalities seen on angiography and how various retinal conditions present on angiography. Finally, it provides an overview of indocyanine green angiography including its principles and advantages over fluorescein angiography.
- Orbital cellulitis is a serious infection of the orbital tissues that does not involve the globe itself. It is most commonly caused by bacterial infection spreading from the paranasal sinuses.
- Physical examination includes assessing vision, eye movements, proptosis, pupil function, and examining the orbit, eyelids and anterior/posterior segments for signs of infection or complications.
- Early diagnosis and treatment with intravenous antibiotics is important to prevent vision loss or life-threatening intracranial infections.
Ocular toxoplasmosis is caused by the protozoan Toxoplasma gondii and is the leading cause of posterior uveitis worldwide. It presents as recurrent inflammation and damage to the retina and choroid that can cause visual impairment. While most infections are asymptomatic, some may experience vision loss due to complications like macular scarring. Diagnosis involves antibody tests and imaging, while treatment focuses on antibiotics, though none can eliminate the parasite permanently.
Leukocoria ( or white pupillary reflex) is an abnormal white reflection from the eye.
Leukocoria is a medical sign for a number of several conditions.
- this presentation at annual conference of the Ophthalmic department, faculty of medicine - Al-Azhar University in association with DOS & EOS Cairo, Egypt January 2017
This document summarizes key information about pyogenic brain abscesses:
- They are focal collections of pus within the brain, most commonly caused by contiguous infections from the ear, sinuses, or mouth spreading via veins.
- Symptoms vary depending on size and location but often include headache, fever, and neurological deficits. Diagnosis involves CT or MRI imaging and treatment involves antibiotics plus surgical drainage for larger abscesses.
Intermediate uveitis is a form of uveitis that causes inflammation in the vitreous humor and peripheral retina. It most commonly affects children and young adults. Symptoms include blurred vision and floaters. If left untreated, it can cause complications like cystoid macular edema, epiretinal membranes, and cataract formation that lead to vision loss. Treatment involves corticosteroids administered topically, periocularly, or systemically. For cases that are resistant to steroids, immunosuppressive therapies may be used. With treatment, most patients have a generally good long-term prognosis with vision of 20/30 or better.
This document summarizes retinal artery occlusion, including classifications, epidemiology, clinical features, risk factors, evaluation, treatment, and prognosis for different types. Central retinal artery occlusion typically causes sudden, painless vision loss and has a poor visual prognosis. Branch retinal artery occlusion often causes partial vision loss and has a better prognosis, with vision recovering to 20/40 or better in most cases. Cilioretinal artery occlusion can occur in isolation or with central retinal vein occlusion, and isolated cases typically have a good visual outcome.
Evaluation of White Pupillary Reflex FINAL.pptxMahfuz Shohag
Leukocoria or white pupillary reflex can be caused by several conditions. The differential diagnosis can be narrowed through history, examination, and investigations. The main differentials discussed were congenital cataract, retinoblastoma, persistent hyperplastic primary vitreous, ocular toxocariasis, Coat's disease, retinopathy of prematurity, and coloboma. Early diagnosis is important as treatment can help save vision for many of these conditions causing leukocoria.
This document discusses intermediate uveitis, including its definition, causes, symptoms, signs, diagnosis, and treatment. Intermediate uveitis involves inflammation in the vitreous, pars plana region, and ora serrata region of the retina. Common causes include multiple sclerosis, Lyme disease, sarcoidosis, and various infections. Symptoms are often floaters and blurred vision. Signs include vitreous cells and snowbank formations in the inferior vitreous. Treatment involves topical or injected steroids, with immunosuppressants used for non-responsive cases.
case report.This is a 60 years old female patient, a known Glaucoma patient:pptxfajrimohammed
The document discusses various causes of unilateral acute granulomatous anterior uvitis with high intraocular pressure (IOP). It describes conditions like glaucomatocyclitic crisis, Fuchs heterochromic iridocyclitis, herpes zoster or simplex-associated uveitis, phacolytic and phacoantigenic glaucoma, and ciliary body inflammation and rotation with angle closure glaucoma that can lead to these symptoms. It also discusses evaluating and managing patients with uveitis and elevated pressure, including recognizing underlying syndromes, controlling IOP and inflammation, and addressing specific conditions like Fuchs heterochromic iridocyclitis and herpetic uveitis.
Phthisis bulbi represents the end stage of ocular atrophy and is characterized by shrinkage and disorganization of the eyeball and intraocular contents. It progresses through three stages: (1) atrophy without shrinkage where intraocular structures are atrophic but the eye maintains normal size, (2) atrophy with shrinkage where the eye shrinks but structures remain organized, and (3) phthisis bulbi where the eye is greatly shrunken and intraocular contents are disorganized. Optociliary shunt vessels are abnormal connections between the retinal and choroidal circulations that can be congenital or acquired due to conditions like central retinal vein occlusion or glaucoma. They are diagnosed by their appearance on
Urrets-Zavalia Syndrome (UZS) is characterized by a fixed, dilated pupil following penetrating keratoplasty (PKP) for keratoconus. The syndrome was first described in 1963 and is thought to be caused by iris ischemia and acute rise in intraocular pressure during or after surgery. Risk factors include the use of mydriatic agents, elevated IOP, presence of keratoconus, and inflammation. Prevention focuses on maintaining a deep anterior chamber and avoiding iris trauma during PKP. Management includes treatments to lower IOP if elevated, with reconstructive surgery if symptoms from the fixed, dilated pupil are present.
case report on pt with uvitic glaucoma pptxfajrimohammed
Uveitis can cause elevated intraocular pressure (IOP) through several mechanisms:
- Inflammatory debris can temporarily block the trabecular meshwork
- Peripheral anterior synechiae and iris incorporation into the angle can gradually cause angle closure
- Posterior synechiae can lead to pupillary block and appositional/synechial angle closure
- Steroid treatment for inflammation can also elevate pressure
When evaluating patients with uveitis and elevated pressure, it is important to recognize particular syndromes like sarcoidosis or juvenile idiopathic arthritis to plan long-term care, and to distinguish glaucomatocyclitic crisis from acute angle closure based on gon
The document discusses orbital implants and ocular prosthetics used to replace eyes removed due to conditions like trauma, tumors, or infection. It describes different types of orbital implants including porous implants made of materials like hydroxyapatite that allow tissue ingrowth, and non-porous implants made of materials like silicone or acrylic. Complications from implants or prosthetics like exposure, extrusion, or socket contracture are also summarized. Maintaining adequate orbital volume with implants is emphasized, as is regular cleaning and replacement of prosthetics.
Pterygium is a common ocular surface lesion originating in the limbal conjunctiva. It has a wing-like appearance that progresses over the cornea more frequently at the nasal limbus. Its pathogenesis is highly correlated with UV exposure from proximity to the equator and outdoor lifestyles. Histologically it is an accumulation of basophilic degenerated subepithelial tissue that destroys Bowman's layer. While considered degenerative, it also exhibits proliferative properties. Treatment includes excision with or without adjunctive therapies like Mitomycin C to prevent recurrence rates between 0-43%.
This document discusses anti-glaucoma medications. It begins by outlining the goal of glaucoma treatment which is to preserve vision by lowering intraocular pressure. Several classes of medications are described including prostaglandin analogues, beta-blockers, alpha agonists, carbonic anhydrase inhibitors, parasympathomimetics, and others. Specific drugs within each class are explained along with their mechanisms of action, dosing, efficacy, and side effects. Target intraocular pressure ranges are discussed based on factors like baseline pressure and damage level.
The document discusses glaucoma and intraocular pressure (IOP). It defines glaucoma as a group of optic neuropathies characterized by progressive optic nerve head damage and visual field loss. While elevated IOP is a strong risk factor, it does not need to be present. The Goldmann equation describes IOP as determined by aqueous formation rate, outflow facility, and episcleral venous pressure. Lowering IOP involves decreasing aqueous formation, increasing outflow, and decreasing episcleral venous pressure.
The Ocular Hypertension Treatment Study found that treating patients with ocular hypertension reduced the risk of developing primary open-angle glaucoma compared to untreated patients. Central corneal thickness was also found to be an independent risk factor for glaucoma. Surprisingly, the study found that diabetes was associated with a reduced risk of developing glaucoma, which contradicted previous studies.
This document discusses different classes of antimicrobial drugs, including their mechanisms of action, spectra of activity, and ophthalmic uses. It covers cell wall synthesis inhibitors like penicillins, cephalosporins, glycopeptides, and carbapenems. It also discusses inhibitors of cytoplasmic membranes, bacterial DNA synthesis, and protein synthesis, including fluoroquinolones, aminoglycosides, tetracyclines, and macrolides. For each class, examples are given and their mechanisms, spectra, pharmacology profiles, indications, and adverse effects are summarized.
This document provides an overview of ophthalmic microsurgery basics, including objectives, outlines, and sections on peculiarities of microsurgery, ophthalmic incisions, blades used, opening the anterior chamber, principles of wound closure, suture materials and needles, and instrument handling. It describes the objectives of learning about ophthalmic incision types, sutures, instruments, wound construction and closure. Key topics covered include characteristics of cutting instruments and tissues, dynamics of incisions, commonly used blades, opening the anterior chamber, principles of wound closure, criteria for ideal sutures, types of suture materials based on absorbability and structure, and tissue reactions to different suture materials.
This document discusses various types of optical aberrations including monochromatic and chromatic aberrations. Monochromatic aberrations include spherical aberration, which causes rays passing through the periphery of a lens to focus differently than central rays. Coma causes off-axis object points to have disparate focal lengths. Chromatic aberration results in different wavelengths of light focusing at different distances, with blue light focusing closer than red light. The human eye exhibits these aberrations but various anatomical features help reduce their effects on vision.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
5. Cont…
• In the Baltimore Eye Survey, the
prevalence of POAG among White
individuals ranged from 0.9% in
those aged 40–49 years
• 2.2% in those aged ≥80 years,
• whereas the prevalence among Black
individuals ranged from 1.2% to
11.3%, respectively.
5
6. Cont…
• The prevalence of PACG varies among racial and ethnic groups.
• A meta- analysis estimated the prevalence
– Asia to be 1.1% among individuals aged 40–80 years; however, it
is even higher in east Asia.
– Among people of European ancestry >40 yrs,estimated to be
0.1% to 0.4%.
– The estimated prevalence in African populations ranges from
0.1% to 0.6%.
– The highest- known prevalence, estimated to be between 2.5%
and 4.8%, is found in Inuit populations >40 years in Alaska and
Greenland.
6
7. Cont…
• Ocular hypertension (OHT) is defined as the presence of
statistically
elevated IOP in the absence of glaucomatous visual field or
optic disc damage.
• A large proportion of patients with OHT do not go on to
develop glaucoma.
7
8. Pathogenesis of Glaucoma
• Glaucoma is a progressive disease characterized by slow
degeneration of retinal ganglion cells (RGCs) and optic nerve
axons.
• The pathogenesis is not fully understood but several theories
are in vogue to explain the varied clinical manifestations.
• There is evidence that RGC death in glaucoma may occur
through a type of
degeneration defined as apoptosis.
8
9. Cont.…..
• Apoptosis can be initiated by various mechanisms:
• Inflammation
• Ischemia
• Neurotoxicity
Glutamate excitotoxicity
Nitrous oxide toxicity
• Neurotrophin deprivation
• Oxidative stress
• Mitochondrial dysfunction
9
11. Cont.…
• corectopia (displacement of the
pupil),
• nevi, nodules,
• exfoliative material
• Transillumination defects, the
presence and patency of an iridotomy
or iridectomy, and any surgically
induced iris abnormalities.
• Iris color should be noted, especially
in patients being considered for
treatment with a prostaglandin
analogue
11
12. Cont…
• Early stages of neovascularization of the anterior segment
may appear as
– Either fine tufts at the pupillary margin or
– A fine network of vessels on the surface of the iris adjacent to the iris
root.
• ocular trauma, such as
– Iris sphincter tears,
– Iridodialysis (tear in the iris root), or
– Iridodonesis
12
13. Cont.…
• contour of the iris
– clues about the under lying mechanism of angle closure.
– choroidal effusion or hemorrhage
– iris or ciliary body cyst or, rarely, uveal melanoma;
13
29. Laser Trabeculoplasty
• (LTP), laser energy is applied to the trabecular meshwork in
discrete
spots, usually covering 180°–360° per treatment.
• The goal of LTP is to reduce IOP by increasing outflow facility.
• Different laser wavelengths and delivery systems can be used
29
30. Cont…
• In all forms of LTP, possible mechanisms of action include the
following:
• stimulation of cell division
• release of cytokines from treated trabecular meshwork cells
resulting in alterations of the extracellular matrix of the TM or
biomechanical changes in the Schlemm canal endothelial cells
• recruitment of monocytes and macrophages in the TM
• increased phagocytic activity of cells in the TM
30
32. Cont…
• Complications
– transient rise in IOP
– Low-grade anterior uveitis
– PAS
– hyphema, corneal inflammation and edema
– reactivation of herpes simplex virus, and persistently
elevated IOP
• Results and long-term follow-up
– 4–6 weeks before evaluating the full effect of treatment
– 80% of patients medically uncontrolled IOP results drop
upto 6-12moths
– 50% of patients with an initial response maintain a
significantly lower IOP level for 3–5 years after treatmet
– The success rate at 10 years is approximately 30%.
32
35. cont…
• Laser Gonioplasty, or Peripheral
Iridoplasty
– is a technique to deepen the
angle.
– plateau iris syndrome,
nanophthalmos, and lens-related
angle-closure.
• Contraindications
– tumors of the iris or ciliary body
and uveitis
35
36. Cyclodestruction
• Internal cyclodestruction (endocyclophotocoagulation)
• External cyclodestruction (trans scleral
cyclophotocoagulation)
• destroying a portion of the ciliary body.
• Cyclocryotherapy
• Nd: YAG cyclodestruction
• Endoscopic cyclophotocoagulation
• Trans scleral cyclophotocoagulation
36
In tuberous sclerosis, glaucoma may occur secondary to vitreous hemorrhage, anterior segment neovascularization, or retinal detachment. A typical external sign of tuberous sclerosis is pink to red- brown angiofibromas,which are often found on the face and chin.
In juvenile xanthogranuloma, yellow or orangepapules or nodules can be pre sent on the eyelids or face. In oculodermal melanocytosis,blue to brown discoloration or darkening occurs on the periocular skin. It can be unilateralor bilateral, and it may be subtle, particularly in persons of African, Asian, or Hispanicancestry.The presence of subcutaneous eyelid plexiform neurofibromas is a hallmark of the type1 variant of neurofibromatosis (NF1, or von Recklinghausen disease). Although glaucoma isgenerally uncommon in patients with NF1, it occurs in 25%–50% of those who have an eyelid plexiform neurofibroma. In these patients, glaucoma is usually unilateral and ipsilateralto the eyelid neurofibroma.Several disease pro cesses with ocular adnexal abnormalities are associated with elevated episcleral venous pressure (see Chapter 8). The presence of a facial cutaneousangioma (nevus flammeus, or port- wine stain) can indicate encephalotrigeminal angiomatosis (Sturge- Weber syndrome). The cutaneous hemangiomas of a closely related condition, Klippel- Trénaunay- Weber syndrome, extend over an affected limb and may alsoinvolve the face and eyes. Orbital varices, arteriovenous fistulas, and superior vena cavasyndrome may also be associated with elevated episcleral venous pressure and secondaryglaucoma. Intermittent unilateral proptosis and dilated eyelid veins are key external signsof orbital varices. Carotid- cavernous, dural- cavernous, and other arteriovenous fistulascan produce orbital bruits, restricted ocular motility, proptosis, and pulsating exophthalmos. Superior vena cava syndrome can cause proptosis and facial and eyelid edema, aswell as conjunctival chemosis. Thyroid eye disease may also be associated with glaucoma;ocular adnexal features of this disease include exophthalmos, eyelid retraction, and motility disorders.Long- term use of prostaglandin analogues may result in ocular adnexal abnormalities, including increased periocular pigmentation and hypertrichosis of the eyelashes.Other reported external abnormalities include orbital fat atrophy, enophthalmos, deepening of the upper eyelid sulcus, upper eyelid ptosis, inferior scleral show, and tightening ofthe eyelids
Examination and assessment of the external ocular adnexae is useful for determining the presence of a variety of conditions associated with secondary glaucomas as well as external ocular manifestations of glaucoma therapy. The entities described in this section are discussed in greater depth andillustrated in other volumes of the BCSC series; consult the Master Index.An example of an association between adnexal changes and systemic disease is tuberous sclerosis (Bourneville syndrome), in which glaucoma may occur secondary to vitreous hemorrhage, anterior segment neovascularization, or retinal detachment. Typical external and cutaneous signs of tuberoussclerosis include a hypopigmented lesion termed the “ash-leaf sign” and a red-brown papular rash (adenoma sebaceum) that is often found on the face and chin. Other changes in the ocular adnexa associated with secondary glaucoma include the subcutaneous plexiform neuromas that are a hallmark of the type 1 variant of neurofibromatosis, the yellow and/or orange papules in juvenile xanthogranuloma, and the skin pigmentation seen in oculodermalmelanocytosis (nevus of Ota).
The overall populationbased prevalence was 4–5 times higher among Black individuals than White individuals.In the Rotterdam Study, a longitudinal population- based study of northern Eu ro peans,the observed prevalence was 1.1% among subjects ≥55 years of age. In the same study cohort, the incident risk of developing glaucoma at 10 years was 2.8%. In both the BaltimoreEye Survey and the Rotterdam Study, half of the subjects with glaucoma were unaware oftheir diagnosis.
Blindness and low vision in Jimma Zone, Ethopia: results of a population-based survey
Altmetric
Original Article
Blindness and low vision in Jimma Zone, Ethopia: results of a population-based survey
Negussie Zerihun & Denise Mabey
Pages 19-26 | Accepted 25 Jun 1996, Published online: 08 Jul 2009
Download citation
https://doi.org/10.3109/09286589709058057
A population-based study on the prevalence of blindness and low vision was carried out in Jimma Zone, south-western Ethiopia between November 1994 and January 1995. A total of 7423 people from a sample of 8215 (90.4%) was examined. Sixty-three (0.85%) were blind (visual acuity less than 3/60 in the better eye) and 125 people (1.7%) had low vision (less than 6/18–3/60).
Cataract and aphakia (52.4%), corneal opacity and phthisis bulbi (25.4%), and glaucoma (9.5%) were the major causes of blindness. Cataract (56.8%), refractive errors (28.8%), and corneal opacity (12.8%) were the major causes of low vision. Corneal opacity from trachoma was responsible for 20.6% of all blindness and 10.4% of low vision. The prevalence of visual impairment due to refractive errors was 5.1/1000 population. Almost 25% of the study population had active trachoma, and 0.9% of pre-school children had signs of vitamin A deficiency.
Out of a total population of 2 million an estimated 17,000 people are blind and 34,000 have low vision (i.e., a total of 51,000 people with visual impairment). Approximately 20,000 people require cataract surgery, 52,000 require lid surgery for trichiasis, 24,000 require spectacles (excluding presbyopia), including 10,000 for significant refractive errors, half a million require treatment for active trachoma and 4,000 require glaucoma treatment.
Aim: To evaluate the prevalence of glaucoma, treatment patterns and patient attitudes in Ethiopia. • Methods: A survey was administered to glaucoma patients in hospitals in Addis Ababa, Ethiopia. • Results: Of the 415 qualified patients, exfoliative glaucoma (17%) was most commonly found in the Gurage population (33%), whereas chronic angle-closure glaucoma (5%) was found in the Amhara/Tigre (6%) population (P = 0.006). Patients were treated with an average of 1.4 ± 0.8 medications: 52% admitted recent noncompliance and 36% had undergone filtering surgery. Patients believed their physician was trying to help them (93%). God wanted them to receive treatment (89%) and their spouse was sympathetic to their disease (82%). Patients noted their community was unaware of their condition (87%) with Muslims [most common in the Gurage population (31%, P < 0.0001)] reporting this the most (25%, P = 0.01). Amhara/Tigre patients strongly believed their doctors were concerned about them (94%, P = 0.04). • Conclusion: The prevalence of glaucoma type varies among ethnic groups in Ethiopia with exfoliation more common in the Gurage population and chronic angle-closure glaucoma more frequent in the Amhara/Tigre population.
A glaucoma suspect is defined as an individual who has 1 or more of the following characteristics:• a suspicious optic nerve or nerve fiber layer appearance in the absence of a visualfield defect• a visual field defect suggestive of glaucoma in the absence of a corresponding glaucomatous optic nerve abnormality• a family history of glaucoma in a first- degree relative• elevated IOP without evidence of optic nerve damage (see the following section OcularHypertension)
Histopathological evaluation shows that the primary site of damage is:• Retinal ganglion cells• Glial cells including the astrocytes and the Müller cells
Apoptosis has been accepted as an important component of glaucomatous neuro degeneration.
Retinal ganglion cells respond to a variety of neurotrophins, such as brain-derived neurotrophic factor, ciliary nerve trophic factor,glial cell-derived neurotrophic factor, and nerve growth factor. These trophic factors are neuroprotective.Impaired neurotrophin transport from the visual thalamus to the soma of RGCs results in their destruction by apoptosis. The retrograde and anterogradeneuronal transport in glaucomatous eyes is disturbed or interrupted at LC.An increased IOP leads to a contusion of nerve fibers squeezing throughcollagenous plates of LC. Additionally, the cerebrospinal fluid pressureinfluences the degree of mechanical stress, due to a pressure gradient acrossthe tissue of the ONH.
Genetic mutations of myocilin (MYOC) are speculated to cause 2–4% of the POAG in the world.
MYOC is exhibited in human trabecular meshwork and several other tissues but not enough is known about its cellular function.• The gene family bcl-2 is capable of producing several proteins that play important anti apoptotic functions, whereas the bax genes produce pro apoptotic proteins. Whether a cell undergoes apoptosis appears to depend on the relative concentrations of proteins each of these gene families is responsible for producing.• After the increased production of bax, a group of cysteine proteases calledcaspases appears to be the key molecules that determine the point of commitment to apoptosis.
Glutamate excitotoxicity: Excess glutamate induces neuronal changes leadingto RGC death, and this paradoxical phenomenon is termed excitotoxicity.Glutamate transporters like glutamate–aspartate transporter and excitatoryamino acid carrier 1 and glutamate receptors are downregulated inglaucomatous eyes following astrocyte activation. This results in deficientglutamate removal from the extracellular space. An elevated extracellularconcentration of glutamate will lead to an increased inflow of calcium into theRGCs through an activation of voltage-gated calcium channels. An excessiveintracellular concentration of calcium leads to neuron damage. After theincrease in neuronal intracellular calcium, there is an increased productionof free radicals including nitric oxide (NO). Nitric oxide neurotoxicity: As a free radical, NO can start a chain of reactions including activation of the p53 protein, disruption of mitochondria function,and the degradation of deoxyribonucleic acid (DNA) that ultimately results in apoptosis. Nitric oxide rapidly reacts with superoxide to form peroxynitrate,which is a toxic free radical capable of extensive neuro degeneration. Ionotrophic receptors neurotoxicity: Activation of N-methyl-D-aspartate(NMDA) and non-NMDA receptors increases the intracellular calcium thatstimulates various enzymes that lead to RGC death. Neuroinflammation: Patients with primary open-angle glaucoma and NTGhave a significant increase in cytokine receptors suggestive of T cell overactivation, which is a result of long-term presence of lymphocytes andantigens from sustained neurodegeneration.Normal-tension glaucoma has been suggested to be an autoimmune neuropathy with presence of autoantigens in these patients and there is epidemiological association of immune-related diseases with 30% of patients with NTG. Heat shock proteins (HSP) and caspase: These assist in protein folding andassembly and help by responding to stress induced by increased IOP. Butwhen they persist, they can induce neuronal apoptosis. Ischemia andexcessive production of HSP antibodies activate caspase. Caspase depletesthe energy sources of the cell, Nicotinamide adenine dinucleotide (NAD),and adenosine triphosphate and thus eventually cleaves and unravels thecellular DNA. It is this rapid cascade of caspase activation that is responsiblefor the speed of cell death that occurs in apoptosis.It has been suggested that excitotoxicity could play a bigger role in damage due to ischemia because there is extensive research linking excitotoxicityto hypoxic conditions. The neurotrophin deprival hypothesis meshes wellwith the traditional mechanical theory.Glial cell activation is noted in glaucoma and the affected cells are theastrocytes in ONH and retina and the retinal Müller cells. The characteristicclinical finding in glaucoma is the ONH excavation that implies tissueremodeling.Ocular blood flow is affected in glaucoma, but it is not well understood ifit is secondary or causal to tissue atrophy. Role of ROSExperimental data suggests:• Hydrogen peroxide can cause trabecular meshwork degeneration thatleads to increased resistance to aqueous outflow.• Trabecular meshwork has antioxidant activities, mainly related to superoxide dismutase–catalase and glutathione pathways, but these are alteredin patients with glaucoma.• Increase in IOP and severity of visual-field defects in patients withglaucoma parallel the amount of oxidative DNA damage affectingtrabecular meshwork.• Vascular alterations associated with glaucoma contribute to the generation of oxidative damage.• Oxidative stress in retinal cells appears to be involved in the neuronal celldeath affecting the optic nerve in POAG.Glaucomatous subjects might have a genetic predisposition renderingthem more susceptible to ROS-induced damage. Clinical trials testing theefficacy of antioxidant drugs for POAG management is an arena of furtherresearch.Role of MetalloproteinasesMetalloproteinases are zinc-containing enzymes that digest extracellularmatrix. The turnover of the matrix is increased in glaucoma that is speculatedto be result of oxidative stress in response to reperfusion injury.Metalloproteinase 9 is secreted by lymphocytes in glaucoma and it:• Is a prerequisite for apoptosis of RGCs.• Is involved in tissue remodeling and is thus responsible for changes inONH and LC.• Is important in the breakdown of the blood–brain barrier and may contribute to development of splinter hemorrhages.• Regulates the corneal thickness.
Posterior bowing of the peripheral parts of the iris result in aconcave peripheral iris, a reverse pupillary blockwith higher pressure in the anterior chamberthan in the posterior chamber. The peripheralpigmented layer of the iris will be rubbed off bythe zonular fi bers during movements of the pupil.This leads to radial transillumination defects orthe so-called “church-window” phenomenon,seen as a crown-like red re fl ex of the fundusthat resembles a rosetta window of a gothicchurch (Fig. 6.4). Pigmented cells are releasedinto the aqueous humor and may be found onthe anterior surface of the iris (Fig. 6.5). Theyare phagocytosed by the endothelial cells of theFig. 6.1 Pseudoexfoliation material on the anterior surface of the lens, some of which has been rubbed off in themid-periphery by the pupilFig. 6.2 Chamber angle of an eye with pseudoexfoliation(arrow white Schwalbe’s ring). In the direction towardsthe cornea there is a very thin dark line (Sampaolesi’sline). Asterisk indicates the bright white scleral spur.Between the scleral spur and Schwalbe’s line is the pigmented trabecular meshwork (grade +3)Fig. 6.3 Chamber angle of an eye with pseudoexfoliation(asterisks bright white scleral spur). Black pigment granules are present in the inferior part of the angle at6 o’clock6.2 The Chamber Angle in Secondary Open-Angle Glaucoma 41trabecular meshwork. This induces an intense orvery intense brown pigmentation of the trabecular meshwork (Scheie grade +3 or +4), especially in the inferior part (Fig. 6.6). AdditionallySampaolesi’s line is very often present. Verticaldeposits of pigment on the corneal endotheliumare called Krukenberg spindle (Fig. 6.7). Eventhe zonular fi bers and the peripheral posteriorsurface of the lens (Scheie’s stripe) are full ofpigment cells (Fig. 6.8).Course: The IOP shows high fl uctuations.Over time – when accommodation is lost due to aging – most of the pigment has been released and the pigment dispersion or glaucoma has“burned out”. Then the pigmentation of the trabecular meshwork becomes less in the inferior part and more prominent in the superior half (“pigment reversal”)
Use the slit lamp and at fi rst adjust the slit in ahorizontal position. Fix the arm of the slit lamp temporally at 60°. The microscope is pointedstraight ahead and the patient is asked to look straight ahead. Shorten the slit to 1–2 mm andmove the slit lamp until it is focused at the cornea. You will fi nd a second slit on the surface ofthe iris and/or the lens (depending on the width of the pupil), that is slightly unfocused (Fig. 5.4).Increase the length of the slit until the two slits meet (Figs. 5.5 and 5.6). Read the length at the scale of the slit lamp (Fig. 5.7) and multiply thisvalue by 1.4 (for values between 1 and 2.5 mm)or add 10% of the value and 0.5 mm. This willgive you the central anterior chamber depth (corneal endothelium to the anterior surface of thelens) in millimeters. An eye with a central chamber depth of 2 mm or less is at risk of developing angle closure. If you measure the right eye youmust only use the right ocular and vice versa forthe left eye.
Fig. 2.1 (a) Cirrus HD-OCT RNFL thickness map of theright eye demonstrating robust RNFL arcuate bundles. No defects are detected on the RNFL deviation map. AverageRNFL thickness, rim area, average C/D ratio, vertical C/Dratio, and cup volume are within normal distribution as compared with age-matched controls within the referencepopulation. Sectoral analysis is also within normal distribution.
(b) The same patient’s left eye, which demonstrates RNFL thinning and attenuation on the thicknessmap, noted by the paucity of orange and red along thenormal RNFL arcuate distribution. On the RNFL deviation map, clear inferotemporal and superotemporal RNFLdefects are noted in wedge-shaped distributions. AverageRNFL thickness, RNFL symmetry between the eyes, rimarea, average C/D ratio, vertical C/D, and cup volume areall below 1% of age-matched controls within the reference population. Sectoral analysis also confirms relativethinning of the superior and inferior quadrants below 1%of the average reference population
Maximal tolerable medical therapy may be defined as the therapeuticregimen that maximizes the benefits of medical therapy while maintaining the quality of life of the patient with glaucoma.• It focuses on both the tolerability of side effects and the therapeuticefficacy of medication. Patients are generally unable to support more thanfour glaucoma medications, and in case of intolerable side effects with<4 medications also, they may be considered to be appropriate candidates for glaucoma surgery.• Since the IOP drop with each additional medication diminishes, patientsdo not significantly benefit from two or more glaucoma drugs at the sametime. An additional 2 mm Hg IOP lowering when adding a second agent toa prostaglandin is difficult to achieve, and the third agent results in almostinsignificant IOP drop.• It is therefore more judicious to think in terms of optimal medical therapy,which generally includes two or three medications, rather than maximalmedical therapy.• Systemic medications including systemic CAIs and hyperosmotic agentsare beyond the scope of maximal tolerable medical therapy. These are,therefore, primarily used as temporising measures, or to overcome a glaucomatous crisis.
EfficacySLT and ALT seem to have similar efficacy in lowering IOP. Approximately 80% of patientswith medically uncontrolled OAG experience a drop in IOP for at least 6 months following LTP. Among patients who had an initial response, 50% maintain a significantly lowerIOP level for 3–5 years after treatment. The success rate at 10 years is about 30%. Highersuccess rates are seen in older patients with primary open- angle glaucoma (POAG) andpseudoexfoliative glaucoma.Treatment can be repeated with SLT and MLT, although success rates seem to declinewith each subsequent treatment. Because the initial ALT treatment is usually applied toonly 180° of the trabecular meshwork, the laser can be applied to the untreated half of themeshwork later, if needed. However, in previously treated areas, repeat ALT may be lesseffective and associated with an increased risk of IOP elevation. SLT can be used in areasof prior ALT treatment, with results similar to those in eyes undergoing repeat SLT. LTP isless effective in patients with angle- recession glaucoma, inflammatory glaucoma, or abnormalangle structure.The Glaucoma Laser Trial (GLT) was a multicenter randomized clinical trial that assessed the efficacy and safety of ALT as an alternative to topical medical therapy in patientswith newly diagnosed, previously untreated POAG. As initial therapy, ALT appeared to beat least as effective as medi cation in reducing IOP, preventing visual field loss, and slowing an increase in cup–disc ratio. The study was flawed in that 1 eye was assigned to ALTwhile the fellow eye was assigned to timolol treatment, which can have an IOP- loweringeffect on the contralateral eye, potentially confounding the results. More than half of theeyes treated initially with laser required the addition of 1 or more medi cations to controlIOP over the course of the study.The Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial was a prospectiverandomized study that compared SLT to medical treatment in the initial management ofocular hypertension and glaucoma. At 36 months, IOP control was similar between the2 groups, while SLT was more cost- effective. Patients who had SLT scored similarly or better on quality- of- life mea sures compared with patients using
ang W, He M, Zhou M, Zhang X. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with open-angle glaucoma: a systematic review and meta-analysis. PLoS One. 2013;8(12):e84270.
he risk of hyphema canbe reduced by pretreating dark irides with an argon or diode laser prior to penetration withNd:YAG laser and/or by coagulating an actively bleeding blood vessel with argon or diode laser.Identify a suitable iridotomy site:▪ Superior site covered by normal lid position (to avoid glare andmonocular diplopia)▪ Nasal quadrant if possible to prevent macular damage (which is notusual)▪ Peripheral site, approximately one-third distance from limbus to pupil(to minimize damage to the lens)▪ Avoid the 12 o’clock position (bubbles produced during the proceduremay obscure the view, hyphema from 12 o’clock is more disturbing)▪ Iris crypt (thinner iris requires less laser energy, thus less damage tothe surrounding tissue and less postlaser inflammation)
The contra-indications of laser peripheral iridotomy are as follows:• Moderate-to-severe corneal edema or opacification• Flat anterior chamber• No or poor anterior chamber view• Corneal decompensation• Failed multiple attempts of laser peripheral iridotomy (LPI)• Poor patient cooperation (relative).In these cases if an iridotomy is required, a surgical iridectomy may beperformed
Peripheral iridoplasty (or gonioplasty) is performed by using a thermal laser (green ordiode) to treat the peripheral iris stroma. This causes contraction of collagen fibers andthinning of the peripheral iris, pulling it away from the angle recess.
Limited eye care service
Become symptomatic after advanced
Ongoing follow up
Economic problem