Ординатура / Офтальмология / Английские материалы / Terminology and Guidelines for Glaucoma 3rd edition_European Glaucoma Society_2008
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VIII. MONOTHERAPY
(IN ALPHABETICAL ORDER)
1ST
CHOICE
SWITCH AMONG 1ST CHOICE
ALTERNATIVES
2ND
CHOICE
© EUROPEAN GLAUCOMA SOCIETY
2 AGONIST
ß-BLOCKERS
CAIs
PROSTAGLANDINS PROSTAMIDES
NON-EFFECTIVE OR CONTRAINDICATED OR SIDE EFFECTS
ADRENERGIC
CHOLINERGIC
GUANETHIDINE
OTHERS
EFFECTIVE AND
NOT CONTRAINDICATED AND NO SIDE EFFECTS
CONTINUE
SEE ALSO CH 3 AND FC IX
FLOWCHARTS
IX. THERAPEUTIC TRIAL OF GLAUCOMA MEDICATIONS
FIRST CHOICE
MONOTHERAPY
EFFECTIVE ON IOP |
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WELL TOLERATED |
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NOT WELL TOLERATED |
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TARGET IOP REACHED
CONTINUE
TARGET IOP
MAINTAINED
PERIODICALLY VERIFY
ENDPOINTS
•QUALITY OF LIFE
•VISUAL FIELD
•OPTIC DISC
•IOP
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CHANGE |
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TARGET IOP |
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MONOTHERAPY |
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NOT REACHED |
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ADD 2ND DRUG
EFFECTIVE ON IOP |
NON-EFFECTIVE ON IOP |
TARGET IOP |
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TARGET IOP |
REACHED |
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NOT REACHED |
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SUBSTITUTE THE 2ND DRUG AND |
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OTHER THERAPEUTIC OPTIONS |
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VERIFY |
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E.G. SURGERY LASER, ETC. |
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EFFICACY/TOLERABILITY |
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IF POOR RESPONSE TO SEVERAL DIFFERENT MEDICATIONS, CONSIDER NON-COMPLIANCE
© EUROPEAN GLAUCOMA SOCIETY
FLOWCHARTS
X. PATHOGENETIC APPROACH TO ANGLE CLOSURE
PUPILLARY BLOCK
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1 |
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AQUEOUS |
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PUPIL |
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SUPPRESSION |
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CONSTRICTION |
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ACETAZOLAMIDE |
PILO 1-2% OR |
AND/OR 2 AGONISTS |
ACECLIDINE 2% |
ß-BLOCKERS |
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2
IRIDOTOMY/IRIDECTOMY
3
FILTRATION
-----
LENS EXTRACTION
PLATEAU IRIS
PUPIL |
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AQUEOUS |
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CONSTRICTION |
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SUPPRESSION |
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PILO 1-2% OR |
ACETAZOLAMIDE |
ACECLIDINE 2% OR |
AND/OR 2 AGONISTS |
DAPIPRAZOLE |
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ß-BLOCKERS |
IRIDOTOMY AND
IRIDOPLASTY
LENS EXTRACTION
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FILTRATION
POSTERIOR AQUEOUS
MISDIRECTION
CYCLOPLEGIA
AQUEOUS
SUPPRESSION
ATROPINE |
ACETAZOLAMIDE |
CYCLOPENTOLATE |
AND/OR 2 AGONISTS |
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ß-BLOCKERS |
YAG LASER
CAPSULOTOMY
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VITREOLISIS
VITRECTOMY
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LENS EXTRACTION
IN ACUTE ELEVATION OF IOP: EXTRAVASCULAR FLUID REDUCTION WITH MANNITOL/GLYCEROL
© EUROPEAN GLAUCOMA SOCIETY
FLOWCHARTS
XI. ACUTE ANGLE CLOSURE WITH PUPILLARY BLOCK – MANAGEMENT
IMMEDIATE |
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i.v./oral ACETAZOLAMIDE OR i.v./oral OSMOTIC |
OPTIONAL |
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TOPICAL: PILOCARPINE 2% |
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ß-BLOCKERS |
KEEP PATIENT SUPINE |
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2 AGONIST (APRACLONIDINE/BRIMONIDINE) |
ANALGESIA |
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STEROIDS |
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CORNEAL INDENTATION USING 4 MIRROR LENS |
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1-2 HOURS |
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ATTACK BROKEN |
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ATTACK NOT |
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BROKEN |
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REPEAT i.v. CAI |
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OR OSMOTICS |
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IRIDOTOMY |
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CLEAR |
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CLOUDY |
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(OR IRIDECTOMY) |
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CORNEA |
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CORNEA |
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TRY TOPICAL 10% GLICERINE |
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IRIDOTOMY |
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(OR IRIDECTOMY) |
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IRIDOTOMY |
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OR IRIDOPLASTY |
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OR IRIDECTOMY |
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REMEMBER: IRIDOTOMY FOR FELLOW EYE
© EUROPEAN GLAUCOMA SOCIETY
FLOWCHARTS
CHAPTER 1
PATIENT EXAMINATION