GLAUCOMA

dr.Yulia Wardany Sp.M

KJF Ilmu Penyakit Mata
FK UNRI/RSUD ARIFIN ACHMAD
DEFENITION

Peningkatan
TIO
Neuropati
optik

Defek
lapang
pandang

Glaucoma
Funduskopi Normal
 GLAUCOMATOUS OPTIC NEUROPATHY (GON)
• CDR > 0.5
• Nasalisasi
• Gambaran lamina cribrosa
• Splinter hemorhage
• Atrofi peripapil
• Asimetri CDR > 0.2
Characteristic pattern to loss of visual field

Rim of optic nerve becomes

thinner as disc caves in and
becomes more cupped
ANATOMY ANGLE
CLASSIFICATION
OPEN ANGLE VS CLOSED ANGLE
POAG RISK FACTORS
 Normal optic disc
OPEN ANGLE GLAUCOMA
EXAMINATION:
C/D 0.6 or greater
Vertical
elongation of disc
Inf.rim thinner
than sup.
C/D asymmetry >
0.2
High IOP(>21 mmHg)

Glaucomatous optic disc

C/D ratio 0,9

C/D ratio 0,6
GLAUCOMA
Tonometry

Schiotz
Applanation
GLAUCOMA
Goldmann applanation tonometer
GLAUCOMA
Tonopen
GLAUCOMA
Goldmann perimeter Glaucoma visual fields
THE VISUAL FIELD
Humphrey automated perimetry
OPEN ANGLE GLAUCOMA
 Silent thief of
POAG asymptomatic
sight
POAG PROGRESSION
GENETIC IN POAG
 NORMAL TENSION GLAUCOMA
(NPG, LTG, NTG)

• Similar to OAG but IOP always < 21 mmHg

• Higher prevalence of vasospastic disorders,
blood dyscrasias, autoimmune diseases
• May be related to episodic hypotension,
hyopthyroidism
SECONDARY OAG

o Lens induced glaucoma

MEDICAL TREATMENT
 Miotics
 Beta-blockers
 Carbonic anhydrase
inhibitors
 Prostaglandin
analogues
 Alpha-2 agonists
SURGICAL TREATMENT

 Argon laser trabeculoplasty

 Trabeculectomy
 Filtering procedure
 Cyclocryotherapy
 Cyclolaser ablation
 Iridotomy
 Surgical treatment of glaucoma
Argon laser Filtration
trabeculoplasty procedures
Filtration blebs
QUIZ 1
• Case: • Pertanyaan:
• Seorang laki-laki 58 tahun • Lengkapi anamnesa untuk
datang dengan keluhan menegakkan diagnosis
pandangan kedua mata • Usulkan pemeriksaan
kabur dan sempit sejak 1 penunjang yang relevan
bulan.
 • funduskopi
STATUS OFTALMOLOGI
• Visus OD: 1/60, OS: 6/60
• Segmen anterior: kornea jernih,
COA dalam
• TIO OD: 30 mmHg, OS:26 mmHg

OD

• Intepretasi Funduskopi
• Tentukan diagnosis dan diagnosis
banding
• Tatalaksana ?
CLOSED ANGLE GLAUCOMA
RISK FACTORS FOR DEVELOPMENT OF
PRIMARY ANGLE CLOSURE
• Axial hyperopia
• Family history of angle closure
• Advancing age
• Female gender
• East Asian ethnicity
• Inuit ethnicity
• Latino ethnicity
• Shallow peripheral anterior chamber
• Short axial length eyes
Canadian Ophthalmological Society evidence-based clinical
practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.
 ANGLE-CLOSURE GLAUCOMAS
• Patients with PACG commonly present with
1 of 3 possible scenarios:

• acute angle closure,

• narrow angle at risk of acute closure with normal
IOP, or
• creeping angle closure with or without elevated IOP .
• Patients may present with what appears to be chronic OAG, but angle closure is
subsequently discovered on gonioscopy.

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.
GLAUCOMA
Anatomy of Angle Closure Glaucoma
SECONDARY ANGLE CLOSURE

Pupil Primary Examples of secondary

Pupil block Primary acute • Posterior synechiae
or chronic • Silicone oil
angle closure • AC IOL without iridectomy
• Lens subluxation or lens swelling
Non-pupil Plateau iris • Posterior mechanisms
block syndrome − Choroidal tumour
− Choroidal effusion
o medication-induced (sulfonamides)
o spontaneous
− Ciliary block
− Lens-induced
• Anterior mechanism
− Angle neovascularization
− Iritis
− ICE syndrome
− Epithelial down growth

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.
 NARROW/CLOSED ANGLE GLAUCOMA
Onset: 50+ years of age

Symptoms Signs
Severe eye/headache Red, teary eye
pain Corneal edema
Blurred vision Closed angle
Red eye Shallow AC
Nausea and vomiting Mid-dilated, fixed
Halos around lights pupil
Intermittent eye ache “Glaucomflecken”
at night Iris atrophy
AC inflammation
NARROW ANGLE GLAUCOMA
Mid-dilated, fixed pupil
NARROW ANGLE GLAUCOMA
Treatment: Peripheral Iridotomy
TREATMENT OF PRIMARY ACUTE
ANGLE CLOSURE
• topical beta blockers : timilolol maleat 0,25% atau 0,5% ed
• topical miotics: pilocarpine ed
• topical alpha-2 adrenergic agents
• topical and (or) systemic carbonic anhydrase inhibitors:
acetazolamide 250 mg atau brinzolamide ed
• Prostaglandins: latanoporost ed
• systemic hyperosmotics: manitol infus, gliserin oral
(DMcarefull)

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.
CONGENITAL GLAUCOMA
 THE CAUSE

• A hereditary factor is occasionally present.

• The IOP elevation is caused by the failure of the
anterior chamber angle and the
trabecular meshwork to develop appropriately during
intrauterine development.
• In these infants, the aqueous humor does not properly
drain, but since the production of aqueous humor is
nevertheless normal,

The intraocular pressure is high

Figure1: The normal chamber angle: on the left is a histological cross-
section; on the right is a drawing of the same

Figure 2: An underdeveloped chamber angle

 CONGENITAL GLAUCOMA
Onset: antenatally to 2 years old

Symptoms Signs
Irritability Elevated IOP
Photophobia Buphthalmos
Epiphora Haab’s striae
Poor vision Corneal clouding
Glaucomatous cupping
Field loss
CONGENITAL GLAUCOMA

Buphthalmos and cloudy corneas

CONGENITAL GLAUCOMA

Buphthalmos,
glaucomatous Normal OS
cupping, and
cloudy cornea
OD

Haab’s striae
TREATMENT
• The treatment is primarily surgical.
• Different surgical procedures
(according to the degree of the maldevelopment and the
clarity of the cornea) GONIOTOMY
• Goniotomy
• Trabeculotomy
• Trabeculotomy + trabeculectomy

• Supplemental treatment options are TRABECULOTOMY

• Medical therapy
• Implant surgery
• Cyclodestructive procedures
QUIZ 2
• Serang laki-laki 50 tahun datang ke IGD
dengan keluhan mata kiri kabur, merah
disertai nyeri kepala hebat, mual muntah,
dan melihat pelangi disekitar lampu

Status oftalmologi: (gambar)

• Funduskopi : sulit dinilai
• TIO OD 13 mmHg
TUGAS • TIO OS 60 mmHg
1. Deskripsikan kelainan segmen anterior
pada gambar
2. Tentukan Diagnosis pasien
TUGAS KELOMPOK
1. Glaukoma Neovaskuler
2. Glaukoma Fakomorfik
3. Glaukoma Normotensi
4. Glaukoma Juvenil
5. Tatalaksana Glaukoma Akut
6. Tatalaksana Glaukoma Kronik
TERIMA KASIH..