angle closure glauc-mt-recent concepts-aios conf kolkata 2010

Download Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

Post on 10-Apr-2018

213 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    1/18

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    2/18

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    3/18

    WH O ESTIMATION (CONTD)

    Glaucoma is second leading cause of preventable blindness and is a leading cause of irreversible blindness in India & nearly 90% of glaucoma remain undiagnosed in India.

    By 2020 nearly 16 million will have glaucoma. Public awareness about Glaucoma-nil.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    4/18

    CLASSIFICATION OF GLAUCOMA(MANY MET H ODS)

    1. Primary and secondary-commonest methodused, some say all glaucoma are secondarysome known, others not.

    2. Anatomic and Gonioscopic-Open and Closeangle

    3. Bio chemical

    4. Genetic

    5. Intraocular pressure based- Low vs High.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    5/18

    ANGLE CLOSURE GLAUCOMA(ACG) E pidemiology of this glaucoma has received less

    attention. Most available information is from hospital based

    survey or population screening of small high risksubpopulation. ACG is as common as OAG specially in Asia. ACG has PAS and/or iridotrabecular apposition

    Presentation-acute or subacute or chronic. For proper and timely therapy early understanding

    of pathophysiology is must.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    6/18

    PAT H OP H YSIOLOGY OF ANGLECLOSUREA. Iris pushed forward from behind

    Partial or absolute pupil block. Malignant glaucoma Cyclitis or C.B. Cysts. Plateau iris Choroidal swelling by serous or haemorrhagic choroid

    detach. Post segment tumor, silicone oil or air. ROP Anteriorly displaced lens

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    7/18

    B. Iris pulled forward

    Inflammatory membrane ICE syndrome Fibrous or epithelial down growth. Iris incarceration in wound

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    8/18

    PRIMARY ANGLE CLOSURE

    Leading cause of glaucoma world wide Relative pupillary block cause in 90% cases

    Plateau Iris & lens block is cause of primaryangle closure

    More common in Asians and Africans .

    Acute is more in whites and chronic form morein Asians.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    9/18

    OCULAR BIOMETRIC AND ACG

    Small crowded anterior segment. Short axial length.

    Shallow AC , less than 2.1 to 2.5 Thick lens Increased ant lens curvature.

    Small corneal diameter Small radius of curvature of cornea.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    10/18

    OT H E FACTORS OF ACG

    Age- Above 40 ,due to increased lens thickness& forward displacement of lens.

    Sex- More common in females 2or3:1 More common in Hyperopes. ACG Gene-One ACG gene has been mapped on

    chromosome 11 which is Autosomal dominant

    nanophthalmos (NNO1) An untreated fellow eye has 40-80% chance of

    developing ACG over next 5-10 years.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    11/18

    PRESENTATIONS OF ACG

    1. Acute

    2. Subacute

    3. Chronic

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    12/18

    OCCLUDABLE ANGLE

    Only a small percentage of shallow AC patients developglaucoma.

    Long follow up is must. Symptomatology even doubtful should be explained to

    pts. Provocative tests limited value. Features of occludable angle

    PAS

    Increased segmental Trabecular pigmentation H/O previous angle closure Positive provocative test AC less than 2 mm.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    13/18

    SECONDARY ANGLE CLOSURE W ITH PUPILLARY BLOCK

    1. Phacomorphic Glaucoma in which laseriridectomy followed by lens extraction is tt of choice.

    2. E ctopia lentis eg Trauma, Marfans syndrome,Homocystinurea, microspherophakia, Weill-Marchesani Syndrome.

    3. Aphakic or pseudophakic angle closureglaucoma.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    14/18

    SECONDARY ACG W ITH OUT PUPILLARYBLOCKA. Neovascular Glaucoma-eg. Systemic vascular disease , diabetes,

    CRV & CRA occlusion, E ales disease, Coats disease, ROP, RD,PHPV, chronic uveitis, Retinoblastoma, Trauma, radiation etc.

    B. Iridocorneal (IC E ) Syndrome eg. Chandler syndrome, progressivecongenital Iris atrophy.

    C. Tumours- Rb, melanoma & metastais.D. InflammationE . Malignant GlaucomaF. RD-Non rhegmatogenousG. E pithelial & fibrous down growthH. TraumaI. Less common-Nan ophthalmos, ROP, and drug induced Secondary

    Gl.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    15/18

    MANAGEMENT OF ACG

    Three things in Glaucoma Therapy is Imp.:-1. When to treat2. How to treat3. Risk Vs Benefits of any tt.Types of treatment1. Medical

    I. Systemic

    II. Local2. Surgical3. Nonsurgical non drug -like laser, cryo etc.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    16/18

    MEDICAL TREATMENT OF ACG

    Aim of medical treatment is prepare pt for laseriridectomy

    Goals of medical tt are:- Reduce IOP rapidly to prevent further damage to optic nerve To clear corneal haziness To reduce inflamation. Pupillary constriction. Prevent formation of synechia . Tt is usually individualized based on efficacy, safety

    tolerability, status of pt and need of pt.

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    17/18

    DRUGS USED IN ACG

    1. SystemicI. MamitolII. GlycerolIII. Acetazolamide

    I. OralII. Im/iv

    IV. Symptomatic

    2. LocalI. PilocarII. TimololIII. Antiinflamatory

    Surgical Tt1. Filtering surgery in chronic2. Lens extraction3. shunts

  • 8/8/2019 Angle Closure Glauc-Mt-Recent Concepts-AIOS Conf Kolkata 2010

    18/18

    LASER T H ERAPY IN ACG(TREATMENT OF C H OICE)

    1. Laser Iridectomy Argon Laser Nd Yag

    2. Laser Gonioplasty or peripheral Iridoplasty-byArgon Laser

    Future Therapy Gene therapy Molecular therapy