Optic Nerve in Glaucoma (Manado 2011)
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Transcript of Optic Nerve in Glaucoma (Manado 2011)
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MaharaniOphthalmology Department
Medical Faculty, Diponegoro University
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GLAUCOMA
Intaocularpressure
Optic
disc
Visual
Field
Introduction
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Optic Disc
Most of clinically detectable
changes Susceptible Early sign
%O&MAL''GLAUCOMA ''
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Direct Ophthalmoscope
Oldest Most (idely used a)out $*+
magnication
porta)le, simply to usescreening large num)ers
a)ility
relative smallpupil
lac- o.stereopsis
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Indirect Ophthalmoscope
not recommended
+ magnication inade/uate detecting small detail
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0lit1lamp 2echni/uescom)ined (ith variety o. lens
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3igh po(er concave contact lens3ru)y lens
1** D mounted to slit1lamp very small eld o. vie( good /uality stereopsis di4cult to o)tain
0lit1lamp 2echni/uescom)ined (ith variety o. lens
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3igh po(er conve+ lens!#D, 56D and 7#D lens
e+cellent stereopsis !#D $+ magnication 56D $8$+ magnication 7#D $8+ (ider eld o. vie(
smaller pupil
Slit-lamp Techniquescombined with variety of lens
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Fundus Dra(ing
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Fundus 9hotography
permanent record allo(s .or detailed e+pense o. the .undus camera s-illed and e+periencedtechnician
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3&2
OT
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%ormal Optic Disc
0i:e and 0hape o. 2he Disc vertical diameter ;
hori:ontal A.rican ; Asian ;
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%ormal Optic Disc
0i:e and 0hape o. 2he Cup near the center o. the disc shape = round to hori:ontally
oval hori:ontal diameter = # > "8$mm
Cup1Disc &atio correlate to disc si:e "? normal disc CD& #,5
%ormal Optic Disc
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%euroretinal &im disc margin 11 edge o. cup I0%2 rule
%ormal Optic Disc
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Glaucomatous OpticDisc
0cleral &ing
%eural &im &etinal nerve )erlayer
Disc haemorage
9eripapillary atrophy
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0cleral &ing
optic disc si:e nodi@erence
LA&G< DI0C 0MALL DI0C
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%eural &im
9&I%0I9AL 9A23OLOGIC Loss o. neural rim
donut rather than theholeB
Di@use and locali:ed
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%eural &im
locali:ed loss o. %& I0%2 rule )rea-
65? glaucoma
%O2C3I%G
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%eural &im
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Cup Asimetry
- CDR- CDR simetris padasimetris pada99.5%99.5% populasipopulasi
-- AsimetryAsimetry > 0.1> 0.1 < 7% of population< 7% of population
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&etinal %erve Fi)er Layer
%O&MAL
right1Dar-1right 9attern
Important compare)et(een " eyes
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&etinal %erve Fi)er Layer
Slitlikeor Groovelike1arcuate nerve )er
)undle1not a sign o.a)normality1li-ely to )e a)normal
1optic disc visualeld%O&MAL
1 Close .ollo(1up
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&etinal %erve Fi)er Layer
Wedge-shaped defects1easiest to detect1sup in. arcuate
1%2G
locali:ed &%FLde.ect
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&etinal %erve Fi)er Layer
Diuse or generalized RNFLloss1most common
1most di4cult to detect1more common in high IO9
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Disc 3emorrhages
splinter Eameshaped chronic ischaemic O%3 " > "? glaucomacases %2G ; OAG ; O32in.erotemporal
transient, may recurIOA Meeting !th Manado "#$$
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associated notching! "#$% defect indication of early progressiveglaucomatous damage eliminated &'D! systemic diss!anticoagulant
Disc 3emorrhages
%O2C3I%G
&%FL D
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9eripapillaryAtrophy
(ona )etainner crescent
adHacent to the disc visi)le sclera (ona *lpha outer crescent
more peripheralirregular
hypopigmentation andhyperpigmentation
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Vascular Changes
%asali:ationnot spesic .or
glaucoma
ayonetting&arely seen innormal
AO%
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Vascular Changes
aring vasculer
Circumlinear vessel%ot specic .orglaucoma*#? in normalpopulation
A&I%G
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GLAUCOMA'
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L< &