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Ophthalomolgy > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

GDD indications

A
  1. Severe conj scarring
  2. Uncontrolled glaucoma e Trab
  3. 2 glaucoma ….
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2
Q

GDD complication

A
  1. Malposition (endo/lens)
  2. Tube erosion, plate migration
  3. Excessive drainage
  4. Early drainage failure (blockage of tube)
  5. Late drainage failure (10%/yr)
  6. Diplopia
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3
Q

NTG RF

A
  1. Elderly, female, Japan, Fh/o
  2. CCT lower
  3. Abnl vasoregulation- migraine, raynaud, DM, HT, carotid insufficiency
  4. Hypotension
  5. OSA
  6. Autoantibodieslevel
  7. Transient pressure gradient
  8. Ocular perfusion pressure lower
  9. Myopia
  10. Thyroid d/s
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4
Q

Tx outline of NTG

A

Regular assessment- perimetry 4-6 monthly

Reduce IOP 30% from baseline slow rate of progression
but without Tx 50% of NTG -> no progression at 5 yr

RF of progression

  1. Female
  2. Migraine
  3. Disc haemorrhage at Dx
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5
Q

Tx of NTG

A
  1. Medical
    • Brimonidine (neuroprotective)
    • CAI dorzolamide(ocular perfusion)
    • Pg
    • Betaxolol (ON perfusion)
  2. SLT
  3. Surgery
  4. Control of systemic vascular d/s
  5. CCB for vasospasm
  6. Reduce antiHT at night
  7. Neuroprotective (memantine, ginkgo, antipl
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6
Q

D/Dx of NTG

A
  1. Angle closure
  2. Low CCT
  3. POAG
  4. Previous episode of raised IOP
  5. Masking by systemic Tx (Oral B blocker)
  6. Spontaneously resolved pigmentary G
  7. Progressive RNFL defects not d/t G
    • myopic degeneration
    • OD drusen
  8. Cong disc anomalies- OD pit, coloboma
  9. ON or chiasmal compression
  10. Previous AION
  11. Previous acute ON insult
  12. Other ON - inflammatory, infiltrative, drug
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7
Q

OD changes more common in NTG

A
  1. Greater rim thinning
  2. PPA crescent more common
  3. Splinter haemorrhage more common
  4. OD pallor more than cupping
  5. OD pits more common
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8
Q

VF changes more common in NTG

A
  1. VF loss closer to fixation

2. Steeper slopes

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9
Q

Devices used to measure IOP

A
  1. GAT
  2. Pneumotonometry
  3. Perkins
  4. Pascal (DCT)
  5. Reichert (ORA)
  6. Tonopen
  7. iCare
  8. Schiotz
  9. Implantable tonometer
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10
Q

Goniolens

A 
1. Indirect
 A) Non-indentation
    1) Goldmann 3 mirror
    2) Magna view
    3) Ritch trabeculoplasty
    4) Khaw direct view
B) Indentation
    1) Zeiss
    2) Posner
    3) Sussman
  1. Direct
    1) Koppe
    2) Barkan
    3) Swan Jacob
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11
Q

Trabeculum PIGMENT

A
  1. PXF, PDS
  2. Iritis
  3. Glaucoma (post ACG)
  4. Melanosis
  5. Endocrine (DM, Addison)
  6. Naevus (cogan Reese$)
  7. Trauma
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12
Q

Blood in Schlemm canal

A
  1. CCF
  2. SW $
  3. SVC obstruction
  4. Ocular hypotony
  5. Post gonioscopy
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13
Q

Shaffer system

A 
G 0 - iridocorneal touch
G 1 - Schwalbe seen, closure high     
             risk, not inevitable 
G 2 - trabeculum seen, closure possible
G 3 - S spur seen, incapable of closure
G 4 - CB seen
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14
Q

Anatomical limbus

A

Anterior limit formed by a line joining end of Bowman and end of Descemet (Schwalbe line)
Posterior limit is a curve line marking transition between regularly arranged corneal collagen fibers to haphazardly arranged sclera collagen fiber

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15
Q

Pathological limbus

A

Anterior limit - same

Posterior limit formed by line perpendicular to surface of conjunctival epithelium about 1.5 mm behind end of Bowman membrane

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16
Q

Surgical limbus

A

Annular band 2 mm wide with posterior limit overlying scleral spur
Divided into
- anterior blue zone (bet BM and Schwalbe)
- posterior white zone (bet Schwalbe and SS)

17
Q

GDD contraindications

A

Borderline endothelial function

Contact lens use - erosion

18
Q

Sites of GDD implant

A

STQ - first
INQ - larger plate
SNQ - smaller plate (SO m/m)
Soil-> inferior Q is preferred

19
Q

Sites of plate and tube

A

EO plate is sutured bet V and H recurs m/s, posterior to m/s insertion

Tube is routed in 1 of 3 ways

  1. Anteriorly to enter AC angle parallel to iris
  2. Into ciliary sulcus in pseudophakic with posterior facing bevel entering 2.5mm from limbus
  3. Through PP, 4mm to limbus, for posterior implantation in eyes a/f complete vitrectomy

Tube is covered with sclera, pericardium or cornea

20
Q

Failed blew

A
  1. Flat without vascularization
  2. Vascularized bleb due to episcleral fibrosis.
  3. Encapsulated bleb (Tenon cyst) characterized by
    a localized
    highly elevated,
    dome-shaped,
    fluid-filled cavity of hypertrophied Tenon capsule, often with engorged surface blood vessels.
21
Q

Causes of failure can be classified according to the site of obstruction:

A
  1. Extrascleral causes include subconjunctival and episcleral
  2. Scleral causes include over-tight suturing of the scleral flap and gradual scarring in the scleral bed.
  3. Intraocular causes are uncommon and include blockage of the sclerostomy by vitreous, blood or uveal tissue or by a variety of thin membranes derived from surrounding cornea or sclera.
22
Q

Posterior embryotoxon

A

Prominent and anterior displaced Schwalbe line

S/- thin, grey-white arcuate ridge on the inner surface of the cornea adjacent to limbus

Ass - Axenfeld-Reiger anomaly
- Alagille $

23
Q

Axenfeld-Reiger $

A

Caused by defective NCC related processes during fetal development

PAX 6 gene mutations
AD

24
Q

Axenfeld anomaly

A

Posterior embryotoxon + anterior peripheral iris strands

25
Q

Reiger anomaly

A

Posterior embryotoxon +
iris stromal hypoplasia+
Ectropion uveae+
correctopia and full thickness iris defect

26
Q

Reiger $

A

Reiger anomaly +
Dental anomalies (hypo, micro)+
Facial anomalies (maxillary hypo, broad Nadal bridge, telecanthus, hypertelorism)
Others (redundant paraumbilical skin and hypospadias, hearing loss, hydrocephalus, cardiac and renal anomalies, congenital hip dislocation)

Ophthalomolgy (11 decks)

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