Dr. Purjanto Tepo Utomo, SpMBagian IP Mata FK UGM /RSUP Dr. Sardjito

Yogyakarta

GLAUCOMA

Second most commonly cause of most commonly cause of visual lossvisual loss in elderly

Affects- 10 % african American > 70- 2% Caucasian > 70

Early detection and treatment can prevent blindness

Glaucoma

Definition : a group of diseases that have in common a characteristic optic neuropathy with associated visual function loss. Although elevated intraocular oressure (IOP) is one of the primary risk factors, its presence or absence does not have a role in the definition of the disease.

GLAUCOMA : Risk Factor

IOPIOP maybe high African racialracial heritage Advanced ageage Family historyFamily history of glaucoma Hypertension, Diabetic, Myopia

Types Of Glaucoma

Primary Open Angle Glaucoma (POAG)POAG)Most common type in elderly

Primary Angle closure glaucoma (PACG)PACG)

Secondary GlaucomaSecondary Glaucoma- Lens induced- Post traumatic glaucoma- Infection

POAG

Clinical features : Insidious in onset Slowly progressive Painless Visual field loss Assymetri of the neuroretinal rim area Focal thinning or notching of the

neuroretinal rim Optic disc hemorrhages Change of the disc rim appearance

POAG : MEDICAL TREATMENT

Halt visual field lossHalt visual field loss Prevent further optic nerve damagePrevent further optic nerve damage Use medication to lower IOP Asses visual field at least once a year

POAG MEDICAL TREATMENT

Beta Blocker (Timolol, levobunolol, metipranolol, carteolol, betaxolole)

Adrenergic Agonist (Epinephrine, dipivefrin, apraclonidine, brimonidine)

Cholinergic agonist (Pilocarpine,Carbachol)

Prostaglandin analog (latanoprost, travoprost, bimatoprost, unoprostone))

Carbonic anhydrase inhibitors (Acetazolamide)

TOPICAL BETA BLOCKERS SIDE EFFECTS Dry eyes Impotence Depression, confussion Bradycardia Worsening of myasthenia gravis Bronchospasm Congestive heart failure

TOPICAL ADRENERGIC AGONIST SIDE EFFECTS

Red eyes Head ache Anxiety Tremor Increased blood pressure Tachyarrhytmias

TOPICAL CHOLINERGIC AGONISTS SIDE EFFECTS

Brow ache Increased bronchial secretion Decreased dark adaptation Diarrhea Nausea, vomiting Apnea

TOPICAL PROSTAGLANDIN ANALOG SIDE EFFECTS

OCULAR IRRITATION Minimal systemic effects

Carbonic anhydrase inhibitor side effects

Malaise, anorexia, depression Serum electrolyte abnormalities Renal calculi Blood dyscrasias

POAG SURGICAL TREATMENT

Laser surgery Filtering surgery Cyclodestructiive surgery of ciliary

body Placemen ot drainage device

PRIMARY ANGLE CLOSURE GLAUCOMA

Increased incidence with age More common in some asian groups Less common in some Caucasian

groups Risk factors : female sex and hyperopia

ACUTE GLAUCOMA SYMPTOM

Severe Ocular pain Frontal headache Blurred vision with halos seen

around lights Nausea, vomiting

Acute glaucoma

ACUTE GLAUCOMA INITIAL TREATMENT

Pilocarpine 2% gtt q 15 minh x 2 Acetazolamide 500 mg po or IV Oral glycerine or isosorbide 1 cc/kg

bodyweight IV mannitol 20% 300 – 500 cc

Diabetes Mellitus

Increased every year 8000 become blind from retinopathy

annualy

Visual loss is late symptom of diabetic retinopathy

Currently much disease is detected too late for effective laser surgery

PATHOGENESIS

High blood sugar levels may affect retinal capillaries

NONPROPLIFERATIVE RETINOPATHY (NPDR)

Retinal blood vessel leak Leakage into macula may reduce vision

PROLIFERATIVE RETINOPATHY (PDR)

Neovascularization Fibrous proliferation Bleeding and traction Retinal detachment, blindness

DM

Laser surgery for retinopathy is most effective before visual loss occurs

Rubeosis Iridis

Vitreous hemorrhages

Retinal detachment