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SOP FOR GLAUCOMA
Dr Mayuri Borgohain
MBBS, MS Ophthalmology
Fellowship Glaucoma
SELECTION OF PATIENTS
1. HIGH IOP
2. CASES WITH RISK FACTORS (AGE >40, F/H/O GLAUCOMA, H/O STEROID USE, POST
RDSX, PKSX, MYOPIA, HYPERMETROPIA, ETHNICITY, DM, HTN)
3. SUSPECTED DISC ON FUNDOSCOPY
4. ACUTE CASES
GLAUCOMA WORK-UP
1. GAT (NORMAL/LOW/HIGH)
2. GONIOSCOPY (DIRECT AND COMPRESSION)
3. DILATE IF ANGLES ARE OPEN
4. FUNDOSCOPY
IF ANGLE CLOSED
1. INVESTIGATIONS: ASOCT - ANGLE
2. LASER PI+STEROID E/D+BRIMONIDIN E/D+/- OTHER AGM EXCEPT PGA
3. FOLLOW UP AFTER 1 WEEK
1 WEEK FOLLOW UP:
1. REPEAT ASOCT-ANGLE
2. REPEAT GONIO PHOTO
3. REPEAT REFRACTION, GAT
4. DILATE FOR FUNDOSCOPY
BASELINE INVESTIGATIONS:
1. PACHYMETRY
2. PERIMETRY 30-2, 10-2
3. OCT RNFL
4. FUNDUS PHOTO 30º
5. GONIO PHOTO
ADDITIONAL INVESTIGATIONS: GCC ( Preperimetric glaucoma, myopia where
diagnosis is difficult)
DVIOP (10AM, 12 AM, 2AM, 4AM, 6AM) BY SINGLE EXAMINER
FINAL DIAGNOSIS
SET TARGET IOP (MILD 15-17, MOD 12-15, SEVERE 10-12, SUSPECT 20%)
MEDICAL MANAGEMENT
1. PGA, BB, CAI, AA, OA, MIOTICS
2. REVERSE UNIOCULAR TRIAL( CHANGE/ADDITION)
3. COMBINATION DRUGS
4. NEWER DRUGS
1. 1ST FOLLOW UP 4-6 WEEKS.
2. TARGET IOP ACHIEVED, FOLLOW UP EVERY 3 MONTHS
3. TARGET IOP NOT ACHIEVED, FOLLOW UP EVERY 4-6 WEEKS.
FOLLOW UP INVESTIGATIONS
1. PERIMETRY 30-2, 10-2
2. OCT RNFL
SURGICAL INDICATION
1. TARGET IOP NOT ACHIEVED WITH MAXIMUM MEDICATIONS
2. INTOLERANCE TO MEDICATIONS/POOR COMPLIANCE
3. CONGENITAL/JUVENILE/SECONDARY GLAUCOMAS
THANK YOU
REFERENCES
SHIELDS TEXTBOOK OF GLAUCOMA
SIHOTA R ET AL. SIMPLIFYING TARGET INTRAOCULAR PRESSURE FOR DIFFERENT STAGES OF POAG AND PACG. INDIAN J
OPHTHALMOL2018;66:495-505

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SOP FOR GLAUCOMA.pptx

  • 1. SOP FOR GLAUCOMA Dr Mayuri Borgohain MBBS, MS Ophthalmology Fellowship Glaucoma
  • 2. SELECTION OF PATIENTS 1. HIGH IOP 2. CASES WITH RISK FACTORS (AGE >40, F/H/O GLAUCOMA, H/O STEROID USE, POST RDSX, PKSX, MYOPIA, HYPERMETROPIA, ETHNICITY, DM, HTN) 3. SUSPECTED DISC ON FUNDOSCOPY 4. ACUTE CASES
  • 3. GLAUCOMA WORK-UP 1. GAT (NORMAL/LOW/HIGH) 2. GONIOSCOPY (DIRECT AND COMPRESSION) 3. DILATE IF ANGLES ARE OPEN 4. FUNDOSCOPY
  • 4. IF ANGLE CLOSED 1. INVESTIGATIONS: ASOCT - ANGLE 2. LASER PI+STEROID E/D+BRIMONIDIN E/D+/- OTHER AGM EXCEPT PGA 3. FOLLOW UP AFTER 1 WEEK
  • 5. 1 WEEK FOLLOW UP: 1. REPEAT ASOCT-ANGLE 2. REPEAT GONIO PHOTO 3. REPEAT REFRACTION, GAT 4. DILATE FOR FUNDOSCOPY
  • 6. BASELINE INVESTIGATIONS: 1. PACHYMETRY 2. PERIMETRY 30-2, 10-2 3. OCT RNFL 4. FUNDUS PHOTO 30º 5. GONIO PHOTO ADDITIONAL INVESTIGATIONS: GCC ( Preperimetric glaucoma, myopia where diagnosis is difficult)
  • 7. DVIOP (10AM, 12 AM, 2AM, 4AM, 6AM) BY SINGLE EXAMINER FINAL DIAGNOSIS SET TARGET IOP (MILD 15-17, MOD 12-15, SEVERE 10-12, SUSPECT 20%)
  • 8. MEDICAL MANAGEMENT 1. PGA, BB, CAI, AA, OA, MIOTICS 2. REVERSE UNIOCULAR TRIAL( CHANGE/ADDITION) 3. COMBINATION DRUGS 4. NEWER DRUGS
  • 9. 1. 1ST FOLLOW UP 4-6 WEEKS. 2. TARGET IOP ACHIEVED, FOLLOW UP EVERY 3 MONTHS 3. TARGET IOP NOT ACHIEVED, FOLLOW UP EVERY 4-6 WEEKS.
  • 10. FOLLOW UP INVESTIGATIONS 1. PERIMETRY 30-2, 10-2 2. OCT RNFL
  • 11. SURGICAL INDICATION 1. TARGET IOP NOT ACHIEVED WITH MAXIMUM MEDICATIONS 2. INTOLERANCE TO MEDICATIONS/POOR COMPLIANCE 3. CONGENITAL/JUVENILE/SECONDARY GLAUCOMAS
  • 12. THANK YOU REFERENCES SHIELDS TEXTBOOK OF GLAUCOMA SIHOTA R ET AL. SIMPLIFYING TARGET INTRAOCULAR PRESSURE FOR DIFFERENT STAGES OF POAG AND PACG. INDIAN J OPHTHALMOL2018;66:495-505