Treatment of

Glaucoma
Glaucoma
Glaucoma is
characterized
by high ÌOP
associated with
optic disk
cupping and
visual field loss
ormal outflow through trabecular
meshwork (large arrow) and uveoscleral
routes (small arrow) and related anatomy.
Ìn primary open-angle glaucoma,
aqueous outflow by these pathways
is diminished.
Ìn angle-closure glaucoma, the iris is
abnormally positioned so as to block
aqueous outflow through the anterior
chamber (iridocorneal) angle.
ormal optic disc. ote the
distinct optic disc margins, the
well-demarcated cup, and the
healthy pink color of the
neuroretinal rim.
The cup-to-disc ratio of this optic
nerve is 0.6. Clinical correlation
with the patient's history and
examination is required to
decide if this optic nerve is
abnormal.
Glaucomatous optic nerve cupping.
The cup in this optic nerve is
enlarged to 0.8, and there is typical
thinning of the inferior neuroretinal
rim, forming a "notch."
'isual Field Ìmpairment
(A)normal
(B)loss of visual field in
the superior and
nasal portion
(C)visual field loss
extends to superior
and inferior portions
(D)Finally,extensive
damage to the entire
visual field occurs,
sparing the very
central portion of
vision.
GIaucoma cIassified according to
etioIogy
W Primary glaucoma
÷ Open-angle glaucoma
÷ Angle-closure glaucoma
W Congenital glaucoma
W $econdary glaucoma
Chronic angIe-cIosure
eovascular glaucoma
Trauma
Open-angle, trabecular
abnormality
$iderosis
Treatment Goal
The goal of glaucoma treatment is to
preserve the visual field of patients and
prevent the loss of visual function that is
associated with the disease.¨
#ef: Survey of Ophthalmology; 2003 Vol. 48(1): S1-S3
% FIRS% %RG%
CI'ING LOW %RG% IOP
WIC IS UNIFORM D ND NIG%
%arget IOP: Definition
Target ÌOP may be defined as a pressure,
rather a range of intraocular pressure
levels within which the progression of
glaucoma and visual field loss will be
delayed or stoped
#ef: Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57
The treatment options of glaucoma includes:
W Drugs
W aser
W Operation
The treatment is decided by many factors:
÷ Type of glaucoma
÷ $tage of glaucoma
÷ Damage done
÷ $tatus of the other eye
÷ Response to other treatment already taken
÷ Patient compliance or reliability about taking
drugs and follow up examination
Operation -Trabeculectomy
'SOPRO%C%ION/
NUROPRO%C%ION
% SCOND %RG%:
GAUCOMA: OPTÌC R' DAMAG
Rise in ÌOP
Mechanical back pressure
On the junction of optic nerve/retina
Reduce the blood supply to the optic nerve
oss of blood supply
RGC loss
PRSIS%NC/
COMPLINC
WI% DRUG %RP IN
GLUCOM MNGMN%
% %IRD %RG%
GIaucoma %herapy: Persistency
Pharmacologic therapy for glaucoma can
be effective only if patients fill their
prescriptions (persistency) and take their
medications as directed (compliance)
#ef: Am. J. Ophthalmol 2004; 137: S3-S12
$o
W et your patients have good
compliance
÷Tell him what is glaucoma
÷How to cooperate with doctor
÷Check your treatment
Differential diagnosis
W Acute conjunctivitis
W Acute angle-closure glaucoma
(acute ACG)
$ymptoms iridocyclitis Acute ACG
Acute
conjunctivitis
'ision
$low
decrease
comparatively
Toboggan normal
Pain position
usually
located in
ocular area
Ophthalmalgia
and migraine
slight or not
ausea and
vomit
o
Be often
accompanied
with
o
$ecretion o o A great deal
signs iridocyclitis Acute ACG
Acute
conjunctivitis
Congestio
n
Ciliary or mixed Ciliary or mixed Conjunctival
Cornea clarity opaque clarity
KP offwhite pigmentary o
Anterior
chamber
ot shallow shallow ot shallow
Aqueous
humor
Flare and cells
Flare and
exudation
ormal
Ìris
Unclear furrow
nodule
$egmental
atrophy of iris
ormal
Pupil $hrink, irregular
Dilate, vertical
oval shape
ormal
Ìntraocular
pressure
ormal or low ÌOP High ÌOP ormal
Thanks!