inflammatory glaucoma by dr. nermin
TRANSCRIPT
![Page 1: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/1.jpg)
Inflammatory glaucoma
![Page 2: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/2.jpg)
• Inflammatory glaucoma, also known as uveitic glaucoma, is a condition in which ocular inflammation causes a persistent or recurrent IOP elevation resulting in anatomical and physiological changes
![Page 3: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/3.jpg)
Diagnostic dilemmas:
1-IOP fluctuation :very sever in inflammatory glaucoma
2-cillary body shut down:occuring in acute exacerbation
3-steriod induced glaucoma4-deficalty to assess fundus and
pirmetry5-iris vessels confuse with NVG
![Page 4: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/4.jpg)
• PathogenesisIntraocular pressure is regulated by a
balance between aqueous humor production and its outflow. During episodes of intraocular inflammation, IOP is typically reduced because of aqueous humor hyposecretion from ciliary body inflammation and increased uveoscleral outflow. Over time, multiple mechanisms can increase the resistance to aqueous outflow during episodes of uveitis, thereby leading to elevated IOP.
![Page 5: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/5.jpg)
Classification:
1-open angle2-closed angle3-Posner-Schlossman syndrom
![Page 6: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/6.jpg)
1 -open angle:
A- acute:either d.t.-trabeculitis-trabecular obestraction
![Page 7: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/7.jpg)
![Page 8: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/8.jpg)
B-chronic:-d.t. trabecular scarring or sclerosis
2ny to trabeculitis-defecult to diagnose
![Page 9: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/9.jpg)
2-closed angle:A- with seclusio pupillaeB-with PAS:mainly in granulomatous
inflamation
![Page 10: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/10.jpg)
![Page 11: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/11.jpg)
![Page 12: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/12.jpg)
c/p:
1-open angle :A-aute:-IOP-open angle-sign of uveitis-+/- keratitis
![Page 13: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/13.jpg)
B-chorinic:-IOP-open angle -no active inflammation -sign of pervious episiod-disc ,field changes
![Page 14: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/14.jpg)
2-closed angle:A- with seclusio pupillae:-IOP-seclusio pupillae-iris bombe-shallow AC-appositional angle closure -sign of previous epesiod
![Page 15: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/15.jpg)
B-with synechial closure: -IOP-shallow AC- angle closure -sign of previous epesiod
![Page 16: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/16.jpg)
• D.D:-Steriod induced -pig.glaucoma-neovascular -PEX
![Page 17: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/17.jpg)
TTT:
• Medical:The following drug is CI:1-miotics2-PG analogue 3-biremonidine4-metipranolol
![Page 18: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/18.jpg)
• So, the 1st line of ttt is B-blockerThen we may use :-CIA (systemic or topical)-Alpha agonist
![Page 19: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/19.jpg)
• TTT of uvitis :• Steriod• Cycloplegic• Cyclosporin• Cytotoxic drugs
![Page 20: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/20.jpg)
Laser PI:• Should be large &multiple• Intensive topical steriod
![Page 21: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/21.jpg)
Surgical ttt:A-pre-op precutions:1-control uveitis for 3 m2-topical steriod 3-systemic steriod
![Page 22: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/22.jpg)
Intra –op precautions:1-aviod combined cat –trab. Surgery2- use MMC 3-tight scleral suture to aviod
hypotony
Post op.:• Steriod tapered ccording to
inflammation
![Page 23: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/23.jpg)
2-GDD:If trab with MMC failedHas good result valves with Small surface area are
preferred 2 step surgery to avoid hypotony
![Page 24: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/24.jpg)
3-cyclodestruction :May cause:-increase inf.-sever hypotony
![Page 25: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/25.jpg)
Posner-Schlossman:
• unilateral recurrent episodes of mild cyclitis and heterochromia.
• Its pathogenesis still remains unknown, with suggested possible associations including an immunogenetic factor involving HLA-Bw54, viral infections (HSV and CMV)
![Page 26: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/26.jpg)
Symp.:• Blurring of vision• Haloes• No pain• No redness
![Page 27: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/27.jpg)
Sign:• The IOP is in the range of 40 – 70
mmHg during an acute attack• Minimal flare• Few cells• Few KPs• No PAS&PS• No shallow AC• Open angle
![Page 28: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/28.jpg)
![Page 29: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/29.jpg)
D.D:• Prodromal stage of ACG-----other eye
shallow AC• Disc form kiratitis------decrease
corneal sensation Ttt:• SteriodAquas subresent
![Page 30: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/30.jpg)
Fuch's Heterochromic Iridocyclitis
• Def.:chronic non-granulomatous ant. Uveitis
• age: middle • Sex: F• Unilat.
![Page 31: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/31.jpg)
Symp:• Decrease VA • Floaters• heterochoromia
![Page 32: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/32.jpg)
Sign:• White eye• Cornea:KPs• Iris:-atrophy-irir nodule-heterochoromia-no PS• Angle:neovasculrization• Vit.:vitrites• Fundus :• systemic
![Page 33: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/33.jpg)
![Page 34: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/34.jpg)
![Page 35: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/35.jpg)
Ttt:• Posterior subtenon steriod• vitrectomy
![Page 36: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/36.jpg)
HSV ant. Uveitis:
• Granuloatous ant. Uveitis• IOP• Sectoral iris atrophy • Spontanous hyphema• Corneal signTtt:• Steriod • Oral aciclovire
![Page 37: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/37.jpg)
![Page 38: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/38.jpg)
Juvenile idiopathic arthritis:
• Inf.arthritis lasting at least for 6wks befor the age of 16
• Classification:-pauciarticular-polyarticular-systemic onset
![Page 39: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/39.jpg)
• Ant. • Unilat• Chronic• Non-granulomatous Symp.:• Asymptomatic• VA• Floaters
![Page 40: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/40.jpg)
Sign:• White eye • Band keratopathy• KPs• Flare &cells• PS• CAT• Glaucoma• VitritisTtt:• Screening• Topical steriod
![Page 41: Inflammatory glaucoma by dr. Nermin](https://reader035.vdocuments.us/reader035/viewer/2022062307/5561b16dd8b42afd708b5807/html5/thumbnails/41.jpg)
Thank you