Ординатура / Офтальмология / Английские материалы / Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001
.pdf
Drugs to treat glaucoma
1.Beta blockers
2.Sympathomimetics
3.Miotics
4.Prostaglandin analogues
5.Carbonic anhydrase inhibitors
•Topical
•Systemic
Laser trabeculoplasty
Indications
•Failed medical therapy
•Primary therapy in non-compliant patients
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Application of 50-100 burns |
• Incorrect focus with oval |
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to junction of pigmented and |
aiming beam |
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non-pigmented trabeculum |
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Correct focus with round |
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aiming beam |
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Indications for Trabeculectomy
1.Failed medical therapy and laser trabeculoplasty
2.Lack of suitability for trabeculoplasty
•Poor patient co-operation
•Inability to adequately visualize trabeculum
3.As primary therapy in advanced disease
Technique (2)
a |
b |
a.Cutting of deep block - anterior incision
b.Posterior incision
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c |
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d |
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c.Excision of deep block
d. Peripheral iridectomy
e |
f |
e.Suturing of flap and reconstitution of anterior chamber
f.Suturing of conjunctiva
Filtration blebs
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Type 1 |
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Type 2 |
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Thin and polycystic |
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Flat, thin and diffuse |
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Relatively avascular |
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Good filtration |
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Microcysts present |
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Good filtration |
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Type 3 |
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Encapsulated |
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Flat |
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Localized, firm cyst |
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Engorged surface vessels |
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Engorged surface vessels |
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No microcysts |
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No filtration |
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No filtration |
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Shallow anterior chamber
Cause |
IOP |
Bleb |
Seidel test |
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Wound leak |
low |
poor |
positive |
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Overfiltration |
low |
good |
negative |
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Malignant glaucoma |
high |
poor |
negative |
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Late bleb infection
Predispositions
•Thin-walled, cystic bleb
•Use of adjunctive antimetabolites
•Bleb trauma
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Blebitis |
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Endophthalmitis |
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Subacute onset |
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Acute onset |
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Milky bleb |
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Hypopyon |
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No hypopyon |
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Guarded prognosis |
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Good prognosis |
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