Glaucoma Flashcards
(31 cards)
Pars plicata components
Ciliary muscle
Ciliary vessels
Ciliary processes
Aqueous composition
Compared to plasma:
15x more ascorbate
lower: protein, calcium, phosphorous
Vary: Na, bicarbonate
Path of molecule from blood to post chamber
Capillary basement membrane
pigmented epithelium basement membrane pigmented epithelium
nonpigmented epithelium
nonpigmented epithelium basement membrane
Goldmann iop equation
Iop = f/c + EVP
Normals
F = 2-3 uL/min
C = 0.28 uL/min/mm Hg (<0.20 abnl)
EVP = 8-12
Direct gonio lenses
Koeppe
Swan Jacobs
Indirect gonio lenses
Goldmann 3-mirror
Zeiss/posner/sussman- can do indentation
Normal GVF
60 deg nas/sup
70 deg inf
100 deg temp
PXG gene
LOXL1 (Chr 15)
Most common cause of Glc a/w retinoblastoma
NVG (75%)
Less commonly 2ndary ACG
Measurement of
A: outflow facility
B: EVP
C: aqueous production
A: tonography
B: manometry
C: fluorophotometry
Most decreased sensitivity in arcuate scotoma occurs in what quadrant?
Superotemporal
CIGTS
Newly dx’ed POAG tx’ed with trab (+-) 5FU vs medication (stepped regimen)
Primary outcome: VF loss
Results: No diff in VF loss at 5 yrs Va initially decreased c surg, but equalized by 4 yrs IOP 17-18 med group, 14-15 trab More VS cat in trab group
Type of Glc a/w Down syndrome
Axenfeld-Rieger
Initial tx of pupillary block 2/2 microsherophakia
Cycloplegics
Glaucoma Laser Trial
ALT vs T 1/2 for POAG
Eyes with ALT 1st had lower iop and better VF/ON status than fellow eye tx’ed c timolol
Conclusion: ALT at least as effective as initial tx c timoptic
CNTGS
145 eyes randomized to obs vs tx c laser/gtts/surg (did not use beta blockers or PGAs)
Goal iop redxn 30%
12% of tx group progressed vs 35% of control, but only p adjusting for FX of cataract
Conclusions:
- dec iop by 30% dec rate of VF loss in NTG, but rate of prog is slow and variable
- RF for progression: migraine, female, disc heme
Low pressure glaucoma tx study (Low GTS)
Compare T1/2 to a-gan in tx of NTG
Progression in 9.1% of a-gan vs 39.2% c T1/2, BUT:
- Hi dropout rate in a-gan group
- multiple ways of measuring progression
EMGT
IOP redxn vs obs in tx of newly dx’ed OAG
Tx group: ALT + betaxolol; Ave iop redxn 25%
- Progression in 45% tx’ed vs 62% obs
- Each 1 mm Hg IOP lowering from baseline to 1st f/u visit (3 m.) dec risk of prog by 10%
- inc cat in tx group
- RF for prog: hi baseline iop, exfoliation, b/L dz, older age, disc heme
AGIS
ALT vs Trab as initial surg in pts c adv OAG not controlled by medical tx.
Main outcome: VF, VA
7-yr results:
- AA pts: ATT is best; VF defects more severe in this group
- Caucasians: TAT is best
- Eyes c iop <18 at all visits had almost no VF prog
- trab inc risk of cat (74% if no comp, 104% if comp)
- RF trab failure: young age, hi iop, DM, postoperative complications
- RF ALT failure: young age, hi iop
- RF blob encapsulation: males, prev ALT (not stat sig)
OHTS
Meds vs obs in ocHTN
Incl criteria: iop 24-32 in one eye and 21-32 in fellow eye c normal VF and ON
Goal: iop redxn of at least 20% and target iop < 24.
Outcome: VF loss, ON damage
Results:
- iop redxn 22.5% in tx group
- POAG dev at 5 yrs in 4.4% of tx group vs 9.5% control
- RF for prog: baseline iop, age, c:d, CCT
TVT
Pts c failed trab OR prior CE/IOL c uncontrolled Glc (iop 18-40) on MMT randomized to trab c MMC vs BGI (350 mm)
1yr results:
- same iop redxn in both groups (ave 12), but fewer meds required in trab group
- failure rate 13.5% c trab vs 3.9% tube (incl persistent hypotony, re-op as failure)
3 yr:
- both groups had no stat sig diff in IOP (~13) and # of meds (~1)
- Failure rate 15% tube vs 30% trab
Pres-free gtts
brimonidine with Purite (i.e. Alphagan-P)
timolol in gel-forming solution
preservative-free timolol maleate
travaprost without BAK (i.e. Travatan Z).
Tx of pupillary block 2/2 subluxed lens
Two LPIs 180 degrees apart
Genes a/w: Axenfeld-Rieger Cong Glc Juvenile Glc Pxe NTG
PITX2 & FOXC1 GLC3A-C, CYP1B1 GLC1A (MYOC) LOXL1 OPTN
