Part 2 Ophthobank > Glaucoma > Flashcards

Glaucoma Flashcards

(51 cards)

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1
Q

Glaucomatous visual field defects

A

Nasal step
Temporal wedge
Arcuate
Paracentral
Arcuate with peripheral breakthrough
Generalised constriction
Temporal sparing field loss
Total field loss

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2
Q

Non glucaomatous visual field loss

A

Enlarged blind spot (papilloedema)
Homonymous hemianopia (Stroke)
Bitemporal hemianopia (pituitary adenoma)
Left central scotoma (central macular disease)
Centrocaecal scotoma (toxic optic neuropathy)
Spiral field defect (functional)

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3
Q

Management of hyphaema

A

Bed rest and globe protection
Avoid blood thinning
Topical steroids
Consider cycloplegia
Treat IOP (avoid carbonic anhydrase inhibitor in sickle cell - worsens acidosis)
Consider AC paracentesis or washout

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4
Q

Risk of hyphaema

A

Rebleeding around 5th day
Initial clot retracts and lyses allowing for secondary episode of bleeding generally more severe leading to glaucoma, corneal staining and synechiae.

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5
Q

What is risk of congenital cataract extraction

A

15-50% develop glaucoma
Typically 3 years post cataract surgery

Risk factors for glaucoma post congenital cataract surgery
- Surgery during 1st year of life
- post op complications
- small corneal diameter

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6
Q

Infant Aphakia Treatment Study

A

Unilateral congenital cataract in 1-6 month olds
Underwent cataract surgery either receiving IOL or no IOL

No difference in glaucoma between groups
Risk of glaucoma at 5 years was 31%
Younger age at surgery higher risk of glaucoma

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7
Q

What is angle recession glaucoma caused by? FEatures?

A

Blunt trauma - angle recession has 10% risk of glaucoma at 10 years
Raised IOP
Asymmetry in AC depth
Pupil and angle
Gonioscopy showing widening of ciliary body band
IOP check at 3m, 6m and yearly

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8
Q

What is ghost cell glaucoma?

A

Associated with vitreous haemorrhage
Thrombi undergo fibrinolysis and RBCs diffuse through vitreous cavity and can accumulate within trabecular meshwork.
Ghost cells visible within 1 month of vitreous haemorrhage

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9
Q

Which agent has lower effectiveness in hypertensive uvieits?

A

Mannitol has lower effectiveness in lowering IOP in eyes with inflammation as there is disruption of the blood aqueous barrier

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10
Q

How do hyperosmotic agents lower IOP

A

Increase in blood osmolality which creates osmotic fluid force
Drop in IOP is produced by causing fluid to shift from vitreous to vascular compartment
Larger the dose the more rapid administration, the greater IOP reduction
LEss effective over time as there is equilibration of the osmotic gradient
If hyperosmotic agent penetrates eye there may be IOP rebound (e.g. in uveitis)

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11
Q

When does steroid repsonse occur? What is it due to? Risk factors?

A

1/3 of population
Few days to 6 weeks of steorid initiation
Prostaglandin inhibition and structural chagnes in trabecular meshwork

Younger age and longer axial length

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12
Q

What is plateau iris configuration

A
  • Pre op condition where the iris root is short and the ciliary body processes may be larger and more anteriorly positioned than normal
    Causes a mechanical repositioning of the peripheral iris and crowding of angle obstructin flow
    PI is first line Rx
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13
Q

What is plateau iris sydnrome?

A

Post operative (after PI) condition where there is a persistent narrow angle capable of closure despite PI
Caused by abnormal anterior displacement of the ciliary body causing unusual position of the perpiheral iris in relation to the trabecular meshwork
Acute glaucoma post PI is diagnostic

TReat with ALPI - ring of argon laser burn to cause cicatricial contraction of the perpiheral iris stroma and tighter the iris and widen angle

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14
Q

What is congenital glaucoma?
Unilateral/bilateral?
M/F
Familial/sporadic?

A

Angle dysgenesis causing reduced aqueous outflow
Bilateral in 70%
M>F
Usually sporadic (10% familial)

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15
Q

Clinical featuers of congenital glaucoma?

A

Watery eyes, photophobia, blepharospasm
Increased IOP
Buphthalmos (enlargement of globe)
Megalocornea
Haab striae (breaks in descemet’s horizontal)
>0.3 cup to disc ratio or difference of 0.2 between eyes

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16
Q

Which anaesthetics raise IOP? Lower?

A

Ketamine raises
Succinycholine raises

Propofol lowers

Intubation may cause falsely elevated

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17
Q

Management of congenital glaucoma

A

Medical treatment used to temporise and avoid surgery - beta blocekrs, congenital anhydrase inibitors, prostaglandin analogues

Mainstay of management is surgery
Goniotomy - opening abnormal angle
Trabeculotomy - opening Schlemm’s canal into AC
Trabeculectomy - drainage from AC to subtenon’s space
Aqueous shunting

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18
Q

What inhaler can cause IOP spike

A

Fluticasone steroid
5% of population can have elevation over 15mmHg

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19
Q

What is Posner Schlossman syndrome

A

Recurrent unilateral episodes of painless high IOP occurring in white eye
40-80mmHg in white eye with minimal flare, occasional cells, no synechiae, open angle

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20
Q

What is ICE syndrome Iridocorneal endothelial

A

Unilateral
Abnormal corneal endothelium migration across angle, trabecular meshwork and the anterior iris causing anterior segment ditortion
20-40y
Female
50% risk fo glaucoma

Treat with medical IOP lowering
Surgery - trab +/- tube +/- cyclodestruction

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21
Q

What are clinical features of ICE syndorme

Study These Flashcards
A

Unilateral blurred vision
Unilateral guttatae/oedema cornea
Increased IOP
Corectompia
Pseudopolycoria (multiple pupils)
Gonioscopy shows broad based peripheral anterior synechiae that may insert anterior to Schwalbe’s line

22
Q

What are ICE syndromes

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A

Chandler syndrome (prodeminantly corneal)
Essential iris atrophy (predominantly iris changes)
Cogan-Reese Syndrome (diffuse naevus or pigmented nodules which probably represent protrusions of iris stroma)

23
Q

PXF syndrome

Study These Flashcards
A

Deposition of white material over anterior semgnet of eye and other organs.
Associated with CVS an cerebrovascular disease (elevatio nof homocysteine levels)
LOXL1 gene on chromosome 15

24
Q

Risk factors of PXF syndrome

Study These Flashcards
A

Age >40
Female
Ethnicitiy - Scandinavian

25
What are clinical features of PXF syndrome
Dandruff material on pupillary border and anterior lens capsule Peripupillar transillumination defects Poor mydriasis Iridodonesis/phacodonesis Gonioscopy: Sampaolesi's line - irregular pigement deposition in the trabeculum anterior to Schwalbe's line
26
What are treatment for PXF glaucoma
Medical as for POAG ALT - suitable oarly on SLT TRabeculectomy
27
What did the collaborative Normal Tension Glaucoma Study show
IOP reduction by >30% slows the rate of field loss from 35% to 12% Without treatment 50% of NTG patients show no progression of VF defects at 5 years Risk factors fro progression - female, migraine, disc haem at diagnosis 12% of aggressively treated - showed progression
28
What factors determine long term IOP outcome in glaucoma tube surgery
Plate surface area - size of capsule (bleb) is determined by plate size Plate material Flow is retructed by capsule around the plate
29
What is the benefit of non-valved implant
Lower IOP on fewer medications but higher tendency for hypotony related complications
30
What is conservative treatment of bleb leak?
Pressure patching Teporarily taper steorids BCL Cyanoacrylate tissue adhesive or fibrin glue Injection of autologous blood in bleb
31
What treatment is congraindicated in glaucoma patients <2 years old
Alpha 2 adrenergic agonist - Brimonidine Causes CNS depression
32
What is primary juvenile glaucoma
Diagnosed >5 Associated with CYP1B1 and MYOC
33
When should congential cataracts be removed?
6 weeks for unilateral cataract 10 weeks for bilateral cataract When risk fo glaucoma is lowest but before visual deprivation leads to intractable amblyopia
34
What are the most common form of congenital cataract
Lamellar cataract - opacification in specific lens zones
35
What are causes of congenital cataract?
Isoalted - usually autosomal dominant Chromosomal - trisomy, 21, 18, 13, Turners Carniosynotosis - premature closure of cranial sutures Incontinentia pigmenti Myotonic dystrophy (Christmas tree - with low IOP) Marfan's Alports - XLR, basement membrane synthesis COL4A5 gene, glomerulonephrisis, sensorineural deafness, eye abnormalities, oil droplet cataract, anterior lenticonus Anterior segment dysgeneisis MEtabolic disorders - Fabry, Wilson, Lowe's (rare XL, reduced activity of phosphatidylinostol bisphosophonate - associated with glaucoma, corneal keloids, hypotonia, renal tubular acidosis) TORCH infection (toxoplasma, rubella, CMV, syphilis, measles, polio, influenza, Herpes TRauma Drugs
36
SLT vs ALT
ALT - argon green, SLT - freq doubles Nd YAG SLT uses larger spot size Degrees ALT 180 SLT 180-360 PAS more likely with ALT LEss hisopathogical destruction with SLT compared with ALT - repeatability Topical steorids post ALT
37
Aniridia gene chormosome? Assoication
PAX6 gene Chromosome 11 20% sporadic and assoicated with increased risk of Wilm's tumour - nephroblastoma - abdominal US 50% develop glaucoma 80% are familial
38
Risk factors for AACG
Female Cinese South East Asian Age >40 Hypermetropia Short axial length Mediacation that can cause pupillary block - antidepressants, antipsychotics, benzodiazepines, anticonvulsants, mydriatics, antihistamines
39
Which vitamin treatment for glaucoma
Vitamin B3 nicotinamide - may help protect retinal ganglion cells by supporting cell energy production
40
TVT study
Trab+MMC vs Baerveldt Tube Tube less likely to fail than trab Failure at 5 years 46.9% trab, 29.8% tube RE-operation rate at 5 years 29% trab, 9% tube Serious complicaitons 20% trab, 22% tube
41
What is Schwartz Matsuo syndrome
Association of anterior segment inflammation and increased IOP arising from RRD Photoreceptor outer segment gains access to aqueous humour from subretinal space and blocks the trabecular meshwork
42
What is pigment dispersion syndrome? Risk factors?
Release of pigment from the mid-peripheral posterior surface of the iris POsterior bowing of mid peripheral iris rubbing against zonules Reverse pupil block causing transient raised IOPin AC relative to PC Autosomal dominant RF Myopia Age 20-40 Male Caucasian
43
What are clinical features of pigment dispersion syndrome?
Pigement on corneal endothelium - Krukenberg spindle - in vertical line Pigment in posterior lens capsule called Zentmeyer's line AC pigments Mid-perpiheral spoke like transillumination Increased lattice degeneration Gonioscopy may show concave peripheral irism Sampaolesi's line
44
What is pigmentary glaucoma?
33-50% of PDS patients Asymptomaptic but may have blurred vision, haloes, redness after xercise Increased IOP and corenal oedema in acute settings
45
What is treatment for PDG
Topical as for POAG ALT good for early stages SLT - high post laser IOP spikes in some cases TRabeculectomy can be effective but increased risk fo hypotensive maculopathy
46
What is PACS vs PAC vs PACG
PACS Contact between iris trabecular meshwork IOP normal No PAS Optic nerve structure and visual function normal PAC IOP elevated and/or there is PAS Optic nerve structure and visual funciton normal PACG: Optic nerve damage/visual dysfunction May have absence of PAS and raised IOP not detected
47
What is EAGLE study
Effectiveness in Angle closure Glaucoma of Lens Extraction Benefits for phaco over laser iridotomy in patients with PAC and high IOP or PACG and no cataract in terms of: IOP control Medication burden Health economic benefits Patient QOL Phaco/CLE definitive intervention for PAC with IOP>30 and PACG
48
What is ZAP study
Zhongshan Angle Closure Prevention RCT examining prophylactic laser PI in people with narrow agnles but no other abonormality (normal IOP no glaucoma) Risk fo developing PAC was 1/1000 at risk eyes /year PAS was main endpoint No indicent glaucoma Acute episodes of angle closure were extremely rare 50% reduction in risk of angle closure in eyes that had prophylactic PI
49
What is LiGHT study
Laser in Glaucoma and OHT study Eye drops vs SLT as first line therapy for OHT and POAG No significant difference in QOL scales 75% drop free at 36 months and SLT more effective 11 patient in drop group requried trab vs non in SLT group
50
Advanced Glaucoma Intervention Study
RCT aiming to determine if advanced medically uncontrolled POAG better treated by ALT or trabeculectomy Lower IOP means less VF progression Black patients did better with ATT whilst white patients did better with TAT
51
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