19. GGLLAAUUCCOOMMAA
TThhee nnoorrmmaall vviissuuaall ffiieelldd:: aann iissllaanndd ooff
vviissiioonn iinn aa sseeaa ooff ddaarrkknneessss::
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25. GGLLAAUUCCOOMMAA
TThhee hhiissttoollooggyy ooff ggllaauuccoommaattoouuss ooppttiicc nneerrvvee
ccuuppppiinngg::
NNoorrmmaall::
GGllaauuccoommaattoouuss::
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29. GGLLAAUUCCOOMMAA
OOHHTTSS CCoonncclluussiioonnss
AAtt 6600 mmoonntthhss,, tthhee
pprroobbaabbiilliittyy ooff ddeevveellooppiinngg
ggllaauuccoommaa wwaass::
99..55%% iinn oobbsseerrvvaattiioonn ggrroouupp
44..44%% iinn ttrreeaattmmeenntt ggrroouupp
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30. GGLLAAUUCCOOMMAA
OOHHTTSS ppaarraammeetteerrss tthhaatt
iinnfflluueennccee tthhee rriisskk ooff
ddeevveellooppiinngg PPOOAAGG
IIOOPP
AAggee
CCuupp-ddiisskk rraattiioo
CCeennttrraall ccoorrnneeaall tthhiicckknneessss
Brought to you by
31. GGLLAAUUCCOOMMAA
PPeerrcceennttaaggee ooff OOHHTTSS ppaarrttiicciippaannttss iinn
oobbsseerrvvaattiioonn ggrroouupp wwhhoo ddeevveellooppeedd PPOOAAGG
((mmeeaann ffoollllooww-uupp == 7722 mmoo))
IIOOPP vvss cceennttrraall
ccoorrnneeaall tthhiicckknneessss
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32. GGLLAAUUCCOOMMAA
NNoorrmmaall cceennttrraall ccoorrnneeaall tthhiicckknneessss:: 554455 –– 555500 uu
AAdddd oorr ssuubbttrraacctt 22..55 mmmmHHgg ffoorr eeaacchh 5500 uu
cchhaannggee iinn cceennttrraall ccoorrnneeaall tthhiicckknneessss
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33. GGLLAAUUCCOOMMAA
TTyyppeess ooff ggllaauuccoommaa
I. Primary:
A. Congenital
B. Hereditary
C. Adult (common types)
1. Narrow angle
2. Open angle
(Normal tension glaucoma)
II. Secondary
A. Inflammatory
B. Traumatic
C. Rubeotic
D. Phacolytic
etc.
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34. CCoonnggeenniittaall GGllaauuccoommaa
OOnnsseett:: aanntteennaattaallllyy ttoo 22 yyeeaarrss oolldd
SSyymmppttoommss
IIrrrriittaabbiilliittyy
PPhhoottoopphhoobbiiaa
EEppiipphhoorraa
PPoooorr vviissiioonn
Signs
Elevated IOP
Buphthalmos
Haab’s striae
Corneal clouding
Glaucomatous cupping
Field loss
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50. TThhiiss ppllaattffoorrmm hhaass bbeeeenn ssttaarrtteedd bbyy
PPaarrvveeeenn KKuummaarr CChhaaddhhaa wwiitthh tthhee
vviissiioonn tthhaatt nnoobbooddyy sshhoouulldd ssuuffffeerr tthhee
wwaayy hhee hhaass ssuuffffeerreedd bbeeccaauussee ooff llaacckk
aanndd iimmpprrooppeerr hheeaalltthhccaarree ffaacciilliittiieess iinn
IInnddiiaa.. WWee nneeeedd lloottss ooff ffuunnddss
mmaannppoowweerr eettcc.. ttoo mmaakkee tthhiiss vviissiioonn aa
rreeaalliittyy pplleeaassee ccoonnttaacctt uuss.. JJooiinn uuss aass
aa mmeemmbbeerr ffoorr aa nnoobbllee ccaauussee..
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51. OOuurr vviieewwss hhaavvee iinnccrreeaasseedd tthhee
mmaarrkk ooff tthhee 2255,,000000
TThhaannkk yyoouu vviieewweerrss
LLooookkiinngg ffoorrwwaarrdd ffoorr ffrraanncchhiissee,,
ccoollllaabboorraattiioonn,, ppaarrttnneerrss..
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52. :-Contact Us
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011- ,011-41425180 ,011-25464531
91-+,91-981830835636+217387
9818569476 othermotherindia@gmail.com
www.other-mother.in
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A WORLDWIDE MISSITION
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And you thought glaucoma was a disease in which there was too much pressure in the eye! So did most ophthalmologists until several years ago.
But pressure certainly plays a role. Glaucoma is just too complicated to fit a nice simple definition.
The Advanced Glaucoma Intervention Study documented that pressure does play a crucial role in the visual field damage of many patients. Note that the greater the percentage of visits in which the pressure was below 28, the less visual field defects developed.
The three mainstays of glaucoma diagnosis are inadequate. The actual intra-ocular pressure is too imprecise, and the changes in the visual field and the optic nerve occur too late to prevent most of the damage.
Sobering facts!
The aqueous humor is manufactured by the non-pigmented ciliary epithelium in the posterior chamber.
Iris Bombe with secluded pupil
Two standard deviations above the mean occurs at about 22-23 mmHg.
Large intra-day fluctuations as seen on the right are a risk factor for glaucoma
Normal anatomy. The aqueous humor is made in the posterior chamber and escapes through the trabecular meshwork of the anterior chamber.
These techniques illustrate the two most common means of measuring intra-ocular pressures. Applanation is probably the most accurate method but requires a slit lamp to use it.
Is this island of vision seen from a right eye or a left eye?
No two disks are alike. Signs suggesting glaucoma as seen in the right photo include a large cup, nasalization of vessels, and pallor of the cup. Note the peripapilary depigmentation on the right which can make the true cup:disk ratio difficult to estimate.
In glaucoma of all types, if not controlled. There is progressive enlargement of the cup, increased pallor of the base of the cup, and nasalization of the disk vessels.
Whie there is lots of variation in glaucomatous disks, three common characteristics stand out: large cups, pale color and nasalization of the vessels.
Note how vessels can hide under the lip of the disk which helps explain the apparent loss of continuity of vessels clinically.
Note that eyes with the thinnest corneas and highest pressures are at the greatest risk for developing open angle glaucoma.
The thinnest corneas with the greatest vertical cup:disk ratios are the most likely to develop open angle glaucoma.
This lecture covers only congenital and adult varieties of glaucoma but it is important to realize there are many other causes.
Haab’s striae are found only in congenital glaucoma.
The right eye in each patient has congenital glaucoma.
The classical signs and symptoms of narrow angle glaucoma.
Anterior chamber angles vary widely. Only Grade I angles are occludable and might lead to an angle closure attack, similar to what a Grade 0 looks like.
When the trabecular meshwork is obstructed, outflow is impaired and pressure rises. This can occur due to congenitally narrowed angles, the development of synechiae (top right), or rubeosis with a flat chamber (bottom right).
Mid-dilated, fixed pupils and cloudy corneas during an angle closure attack.
The permanent surgical cure for narrow angle glaucoma.
Remember: most patients with open angle glaucoma have no symptoms. This is the best reason to have periodic eye examinations with pressure checks and optic nerve evaluations.
No treatment works all the time!
Mechanisms of drug action vary and many people require multiple medications.
These are the two most common surgical procedures for open angle glaucoma with success rates of 80+%.
Creating a path for the aqueous to escape into the sub-conjunctival space is the aim of filtration surgery.