G L AU C O M A

d r. M u h a m m a d I q b a l S p . M
M.Hashemy AL-Ghozi HSB
Siti Sarah Rahmawati

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1. Peripheral iris

2. Cilliary body band

3. Scleral Spur

4. Trabecular Meshwork

5. Schwalbe Line
 INTRODUCTIO
Definition
N
•

• Optic neuropathy, visual field defect, mostly followed by increased

intraocular pressure
• Optic nerve
• glaucomatous optic nerve head
• Second leading cause of blindness, irreversible

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 INTRODUCTIO
Classification
N
•

• Primary vs
Secondary
• Open vs Closed
• Chronic vs Acute

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 EVALUATI
• Visual acuity
ON
• Visual field
• IOP
• Contact
• Non-contact
• Gonioscopy

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 PRIMARY OPEN ANGLEGL
History
AUCOMA Clinical Findings
• •

• Chronic-progressive • Glaucomatous optic nerve atrophy

• Painless • Visual field defect
• Tunnel vision • Increased IOP
• Asymptomatic until late stage • Open angle
• VA may be 6/6 • Gonioscopy -> ophthalmologist

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 PRIMARY OPEN ANGLEGL
AUCOMA
Risk Factors
•

• Family history
• Older age
• Race
• Myopia
• Systemic disease: diabetes mellitus, hypertension,
CRVO

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 PRIMARY OPEN ANGLEGL
AUCOMA
Pathophysiology
•

• Obstruction of the TM by foreign material

• Loss of trabecular endothelial cells
• Reduction in pore density and size in the inner wall of
endothelium Schlemm's canal
• Loss of giant vacuoles in the inner wall endothelium of Schlemm's
canal
• Loss of normal phagocytic activity
• Disturbance of neurologic feedback mechanism
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 PRIMARY OPEN ANGLEGL
AUCOMA
Diagnosis
•

• Anatomical findings of glaucomatous ONH

• Visual field defect
• Open-angle in gonioscopy
• Increased IOP

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 PRIMARY OPEN ANGLEGL
AUCOMA
Differential Diagnosis
•

• Normotension glaucoma
• Ocular hypertention
• Secondary open angle glaucoma

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 PRIMARY ANGLE CLOSURE
• Introduction
GL AUCOMA
Clinical Findings •

• Chronic disease • Glaucomatous optic nerve atrophy

• Anatomical findings -> peripheral • Visual field defect
anterior synechiae
• Increased IOP
• May induce acute condition
• Closed angle

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 PRIMARY ANGLE CLOSURE
• Risk Factors
GL AUCOMA
• Family history
• Women > Men
• Race
• Hyperopia
• Systemic disease: diabetes mellitus, hypertension,
CRVO

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 PRIMARY ANGLE CLOSURE
• Pathophysiology
GL AUCOMA
• Pupillary Block
• Plateu Iris
• Anterior
displacement
of the lens

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 PRIMARY ANGLE CLOSURE
• Diagnosis
GL AUCOMA
• Anatomical findings of glaucomatous ONH
• Visual field defect
• Closed-angle in gonioscopy
• Increased IOP

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 EDUC
Visual prognosis
ATE
•

• Long-term drug use

• Family screening
• Risk of acute attack
• Routine evaluation

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 MEDIC AL
THERAPY
Reduced aquos production
•

• Beta blocker: timolol

• Carbonic anhydrase inhibitor: acetazolamide
• Alpha 2-selective adrenergic agonist: apraclonidine
• Increase outflow
• Prostaglandin analog: latanoprost
• Parasympathomimetic agents: cyclopegic

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 SURGIC AL
• Laser
THERAPY
• Incisional surgery
• Cyclodestruction

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THANK
YOU
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