Term
| Name 5 aspects/characteristics of the eye that are glaucoma risk factors |
|
Definition
IOP
Characteristics of Optic Nerve Head
Nerve Fiber Layer
Chamber Angle
Corneal Thickness |
|
|
Term
| 5 Nerve head characteristics/changes that may be indicative of glaucoma |
|
Definition
Cup excavation
Rim tissue loss
Vertical cup elongation
Assymetric C/Ds
Peripapillary atrophy |
|
|
Term
| How may corneal curvature affect GAT readings? |
|
Definition
steeper cornea=falsely high reading
Flatter cornea=falsely low reading |
|
|
Term
| How may corneal thickness affect tonometry readings? |
|
Definition
Thicker cornea=falsely high IOP reading
Thinner cornea=falsely low |
|
|
Term
| Only disc change that is completely diagnostic of glaucomatous damage |
|
Definition
| progressive thinning of neural rim |
|
|
Term
| Average disc diameter in mm |
|
Definition
|
|
Term
| What is the C/D ratio where risk of glaucoma increases? |
|
Definition
|
|
Term
| How much difference in C/D ratios between eyes is suggestive of glaucoma? |
|
Definition
|
|
Term
| How may refractive surgery affect tonometry readings? |
|
Definition
| Since the cornea is permanently thinner it may give falsely low readings |
|
|
Term
| Name 3 possible explanations for depigmentation of the peripapillary region |
|
Definition
Glaucoma
High myopic atrophy
normal variation |
|
|
Term
| What areas around the optic disc most commonly have brightest and thickest nerve fiber layer? |
|
Definition
| In the superior and inferior arcades around the optic disc |
|
|
Term
|
Definition
| Inferior temporal wedge defect |
|
|
Term
| flame-shaped hemorrhage crossing the optic nerve edge, highly characteristic of glaucoma |
|
Definition
| Splinter/Drance Hemorrhage |
|
|
Term
| Which type of glaucoma are Drance hemorrrhage's particularly indicative of? |
|
Definition
|
|
Term
| Common location for splinter hemorrhages |
|
Definition
| Inferior temporal disc margin, but can be anywhere around disc rim |
|
|
Term
Standard instrument for visual field evaluation...?
Standard tests...? |
|
Definition
Humphrey perimeter
30-2 and 24-2 Threshold tests are standard |
|
|
Term
| Describe the first field defects usually detected in glaucoma |
|
Definition
| relative paracentral scotomas between 5 and 20 degrees of fixation |
|
|
Term
| Describe how visual field defects tend to progress in glaucoma |
|
Definition
| the areas of depressed sensitivity enlarge and deepen along the arcuate nerve fibers until they coalesce and join the blind spot (arcuate defect) |
|
|
Term
| How may blue-yellow visual field defects compare to white-white defects? |
|
Definition
| B/Y deficits may precede W/W VF losses by 3-4 years, but B/Y does not take media opacities into account. |
|
|
Term
| Which ganglion cells are targeted with Frequency Doubling Technology |
|
Definition
| Magnocellular Cells (Large diameter) |
|
|
Term
Which instrument is a laser scanning ophthalmoscope in which low-intensity polarized light is used to measure the polarization properties of the bifringent nerve fiber layer to calculate its thickness
|
|
Definition
| GDx Nerve Fiber Layer Analyzer |
|
|
Term
| Which instrument can image layers of the eye using light waves |
|
Definition
| Optical Coherence Tomography |
|
|
Term
| Name some situations where initiation of glaucoma treatment is indicated |
|
Definition
POAG in one eye, ocular hypertension in the other
Ocular hypertension in one or both eyes
High IOP (most say over 30)
Progressive rise in IOP
Risk factors and Ocular HTN
Monocular and Ocular HTN suspect
Hx of Retinal Vascular Occlusive Dz with IOP >21mmHg |
|
|
Term
| 3 Factors that contribute to IOP |
|
Definition
Aqueous secretion
Outflow resistance
Epscleral venous pressure |
|
|
Term
| What is responsible for 80% of aqueous secretion |
|
Definition
active secretion by non-pigmented ciliary epithelium
|
|
|
Term
| What is responsible for 20% of aqueous secretion |
|
Definition
ultrafiltration
diffusion
(passive secretion) |
|
|
Term
| Describe the pathway responsible for 80-90% of aqueous outflow |
|
Definition
Trabecular
TM -->Schlemm's canal-->collector channels
-->episcleral veins |
|
|
Term
| Describe the pathway of aqueous outflow responsible for 10-20% of outflow |
|
Definition
Uveoscleral Outflow
Tissues of chamber angle--> thu ciliary muscle --> supraciliary space -->suprachoroidal space -->sclera
|
|
|
Term
| Name 3 pathogenesis theories of glaucoma |
|
Definition
1) direct mechanical damage to axons due to IOP
2) Raised IOP causes ischemia and subsequent nerve fiber death
3) Genetic propensity to apoptosis |
|
|
Term
| 3 Main pharmocological glaucoma treatment mechanisms |
|
Definition
Reduced aqueous production
Increased aqueous outflow
Neuroprotection |
|
|
Term
| Name 3 drug types used to decrease aqueous production |
|
Definition
beta blockers
alpha-2 agonists
CAIs |
|
|
Term
| Name 4 drug types used to increase aqueous outflow |
|
Definition
Miotics
Adrenergic/alpha-2 agonists
prostaglandins/prostamides
Docosanoids |
|
|
Term
| What must happen to beta receptors for tachycardia and increased cardiac output? |
|
Definition
| stimulation of beta 1 receptors |
|
|
Term
| what must happen to beta receptors for bradycardia and decreased cardiac output |
|
Definition
|
|
Term
| what must happen to beta receptors for bronchial dilation to result |
|
Definition
| stimulation of beta 2 receptors |
|
|
Term
| what must happen to beta receptors for bronchoconstriction/spasm to result |
|
Definition
|
|
Term
| Name the only Beta 1 selective beta blocker discussed in class for glaucoma treatment |
|
Definition
|
|
Term
| Which beta blocker is the gold standard? |
|
Definition
|
|
Term
| Which topical beta blocker has the longest half life |
|
Definition
|
|
Term
| Which topical beta blocker creates risk of uveitis? |
|
Definition
| Metipranolol (Optipranolol) |
|
|
Term
| Which topical beta blocker also has intrinsic sympathomimetic activity? |
|
Definition
|
|
Term
| What is the general application regimen for topical beta blockers |
|
Definition
| 1 drop BID, however QD may be enough |
|
|
Term
| Mechanism of topical beta blockers used to treat glaucoma |
|
Definition
| block the beta receptors in the ciliary body to reduce aqueous production |
|
|
Term
| CNS side effects of beta blockers |
|
Definition
Depression (most common)
Fatigue
decreased libido
headaches
hallucinations (rare)
dizziness |
|
|
Term
| which topical beta blockers tends to cause the least CNS side effects |
|
Definition
| Carteolol, due to less blood brain barrier crossing |
|
|
Term
| Name 3 Ocular side effects of topical beta blockers |
|
Definition
stinging/burning
blurred vision
superficial punctate keratitis |
|
|
Term
| 4 Heart side effects of beta blockers |
|
Definition
Bradycardia
arrhythmia
palpitation
congestive heart failure |
|
|
Term
| 2 hematological side effects of beta blockers |
|
Definition
disrupt lipid levels (except Carteolol)
masks hypoglycemia |
|
|
Term
| 3 possible lung side effects of beta blockers |
|
Definition
Bronchospasm
restricted breathing
respiratory failure |
|
|
Term
| 4 Contraindications for Beta Blockers Treatment |
|
Definition
Bronchial obstruction/asthma
Chronic Obstructive Pulmonary Disease
Bradycardia/Congestive Heart Failure
Uncontrolled Diabetes/Hyperlipidemia |
|
|
Term
| Name 3 things that must be checked before treating a patient with a beta blocker |
|
Definition
Blood Pressure
Pulse
Respiration |
|
|
Term
T/F
Systemic Beta blockers can lower IOP |
|
Definition
|
|
Term
| Name 2 drugs found in CoSopt |
|
Definition
| Dorzolamide 2% and Timolol 0.5% |
|
|
Term
| Compare reduction in IOP using Dorzolamide vs. Cosopt |
|
Definition
Dorzolamide (Trusopt)=15-20%
Cosopt=30-35% |
|
|
Term
| Name 1 advantage of using Brinzolamide over dorzolamide |
|
Definition
|
|
Term
|
Definition
Acetazolamide
Methazolamide |
|
|
Term
| Light blue cap indicates what concentration |
|
Definition
|
|
Term
| Yellow cap indicates what concentration |
|
Definition
|
|
Term
| Which beta blocker tends to have the least sting |
|
Definition
|
|
Term
| 1 advantage and 1 disadvantage of Methazolamide compared to acetazolamide |
|
Definition
| Methazolamide has less side effects, however it is more expensive |
|
|
Term
| 2 indications for use of systemic CAIs |
|
Definition
eg. Acetazolamide or Methazolamide
Angle Closure glaucoma (emergency)
Complex glaucoma that does not respond to other treatment
Pseudotumor Cerebri |
|
|
Term
| 4 Ocular side effects of CAIs |
|
Definition
Superificial punctate keratitis
Ocular allergy
Sting/burn/discomfort
Decreased Endothelial Cell Fxn |
|
|
Term
|
Definition
bitter taste/loss of appetite
sulfa allergies
Dyscrasias
headaches
nausea
fatigue
urolithiasis
tinnitus
paresthesias
electrolyte disturbances
|
|
|
Term
| 4 Contraindications for CAIs |
|
Definition
Sulfa allergy
Sickle cell anemia/other blood dyscrasias
Corneal surgery
Corneal Epithelial/Endothelial Disease |
|
|
Term
| Why is dipivefrin better than normal epinephrine? |
|
Definition
| It has increased lipid solubility and thus it penetrates 17x better than epinephrine |
|
|
Term
| Dipifevrin is a prodrug that converts to which substance? |
|
Definition
|
|
Term
| Which receptors are affected by dipivefrin |
|
Definition
| Alpha and beta receptors (adrenergic) are directly stimulated |
|
|
Term
| 3 Cardiovascular side effects of dipivefrin |
|
Definition
Tachycardia
arrhythmias
Hypertension |
|
|
Term
| Ocular Side effects of Dipivefrin |
|
Definition
Pupil dilation
Irritation
Adenochrome deposits
Lacrimation
Initial elevation of IOP
Cystoid Macular Edema |
|
|
Term
| 2 Contraindications for propine (epinephrine) and the reason for them |
|
Definition
Aphakes
Pseudophakes
Due to risk of Cystoid Macular Edema |
|
|
Term
| Mechanism of Apraclonidine |
|
Definition
| Stimulates alpha 2 receptors, resulting in reduced aqueous production and increased uveoscleral outflow |
|
|
Term
| Concentration and dosage of apraclonidine ophthalmic solution |
|
Definition
|
|
Term
| Which drop is used in treatment of post-surgical IOP spikes? |
|
Definition
| Apraclonidine, will help get the pressure down quickly and has a short term effect |
|
|
Term
| Give 1 reason why brimonidine is better than apraclonidine |
|
Definition
|
|
Term
| Why are alpha 2 agonists contraindicated in children |
|
Definition
| Can cause fatal heart arrhythmias |
|
|
Term
| 2 contraindications for alpha 2 receptor stimulators |
|
Definition
MAO Inhibitors
Heart Disease |
|
|
Term
| Name 3 Adrenergic agonists used to increase aqueous outflow |
|
Definition
Dipivefrin
Apraclonidine
Brimonidine
|
|
|
Term
| Nam2 cholinergic agonists (miotics) used to increase aqueous outflow |
|
Definition
|
|
Term
| Name 3 prostaglandins/prostamides used to increase aqueous outflow |
|
Definition
Latanoprost
Travoprost
Bimatoprost ('mide) |
|
|
Term
|
Definition
Glycerol
Mannitol
Isosorbide
Urea |
|
|
Term
| Side effects of brimonidine (alphagan) |
|
Definition
Hyperemia
Sting/burn/FB
blur
dry mouth
headache
fatigue/lethargy |
|
|
Term
| Name 2 drugs found in Combigan |
|
Definition
Brimonidine (0.2%)
Timolol (0.5%) |
|
|
Term
| What is a disadvantage found with the use of Combigan |
|
Definition
| It is not as effective in lowering IOP as using both brimonidine and timolol separately |
|
|
Term
| Name 3 forms of pilocarpine available for glaucoma treatment |
|
Definition
0.25-10% solutions
4% gel
1-3% Membrane solution (slow release) |
|
|
Term
| How many times a day is pilocarpine administered |
|
Definition
|
|
Term
| 3 types of glaucoma that pilocarpine is indicated for |
|
Definition
POAG
Angle closure
Pigmentary |
|
|
Term
| 8 Ocular SE of pilocarpine |
|
Definition
Decreased night vision due to miosis
VF constriction
Myopia
fluctuating vision
Browache
Retinal detachment for some pts
Pupillary block
blood-aqueous barrier breakdown |
|
|
Term
| Systemic side effects of pilocarpine |
|
Definition
salivation
perspiration
hypotension
bradycardia
bronchospasm
abdominal pain
diarrhea
nausea/vomiting
headache |
|
|
Term
| Pilocarpine Contraindications |
|
Definition
<40 yo
Retinal detachment history
high myopia
lattice/holes/breaks
cataracts
inflammatory/uveitic/neovascular glaucoma
|
|
|
Term
| Why is pilocarpine contraindicated for inflammatory/uveitic/neovascular glaucomas? |
|
Definition
| It increases the surface area and subsequently exacerbates the inflammation. |
|
|
Term
| Which other glaucoma medication does not work well with pilocarpine |
|
Definition
| Prostaglandins like Latanoprost (Xalatan) |
|
|
Term
| 4 uses of pilocarpine discussed in class |
|
Definition
Glaucoma tx
Diagnose Adie's pupil
Diagnosis of fixed pupil
possibly treatment of accommodative esotropia |
|
|
Term
| Single most effective category of glaucoma medication |
|
Definition
|
|
Term
| First choice drug in glaucoma tx |
|
Definition
|
|
Term
| Why are pilocarpine and latanoprost not used together |
|
Definition
They counteract one another,
latanoprost opens up the ciliary body spaces while pilocarpine constricts it |
|
|
Term
| 2 Drugs founds in DuoTrav (Canadian) |
|
Definition
|
|
Term
| Compare Latanoprost (Xalatan) with Travaprost (Travatan) |
|
Definition
| Travatan=no refrigeration, same side effects but lower risk of them (uveitis) |
|
|
Term
| 2 Meds found in Extravan (pending) |
|
Definition
|
|
Term
| Difference b/w Travatan and Travatan Z |
|
Definition
| Z version has no benzalkonium chloride (BZK) |
|
|
Term
| Name the prostamide drug used in glaucoma treatment |
|
Definition
|
|
Term
| 2 Concentrations bimatoprost comes in and the difference? |
|
Definition
0.03%
0.01%-more BZK in it |
|
|
Term
| Latisse is a formulation of which glaucoma medication |
|
Definition
| Bimatoprost (Lumigan) 0.03% |
|
|
Term
| First preservative free prostaglandin analogue |
|
Definition
Tafluprost (Zioptan) 0.0015%
Saflutan in Europe |
|
|
Term
| Which drug class has a side effect of darkening ocular tissues? |
|
Definition
|
|
Term
| Side effects of prostaglandins |
|
Definition
>Darkening of:
-iris
-lashes/periocular hair
-eyelids
>CME in aphakes/pseudophakes
>Uveitis
>Herpes virus reactivation |
|
|
Term
| Prostaglandin contraindications |
|
Definition
aphakia
recent pseudophakia
History of uveitis or herpes simplex
YAG laser
cosmesis
cost |
|
|
Term
| Which hyperosmostic is contraindicated for diabetics? |
|
Definition
|
|
Term
| Which 2 Hyperosmotics are via IV administration |
|
Definition
|
|
Term
| Indications for hyperosmotics |
|
Definition
High IOp >40mmHg
Angle closure |
|
|
Term
| What is the Ocugene test used for? |
|
Definition
| Uses DNA to determine one's risk for developing glaucoma. |
|
|
Term
| Steroids may be used to treat what type of glaucoma? |
|
Definition
| Inflammatory glaucoma such as uveitic or chemical burn glaucoma. |
|
|
Term
| Name 2 Steroids that have less propensity to increase IOP compared to other steroids |
|
Definition
| Lotemax (Loteprednol) and FML |
|
|
Term
| Name 3 options for initial glaucoma treatments including dosage |
|
Definition
1. Beta blocker QD
2. Brimonidine BID
3. Prostaglandin HS |
|
|
Term
| At what point in glaucoma therapy is an Oral CAI considered? |
|
Definition
| As a last resort after other medications and surgeries have failed to control the disease. |
|
|
Term
| 2nd step in therapeutic flow chart for glaucoma therapy (after using a single drop) |
|
Definition
Combination of 2 of either a beta blocker, brimonidine or prostaglandin
OR
add docosanoid |
|
|
Term
| 3rd step in glaucoma treatment |
|
Definition
| Add a topical CAI TID monocular |
|
|
Term
| 4th step in glaucoma therapy |
|
Definition
| Surgery= LTP or trabeculectomy |
|
|
Term
| How often do you need to see your stable glaucoma patient? |
|
Definition
|
|
Term
| How is laser treatment of POAG expected to affect IOP? |
|
Definition
| Initial spike, then 8-10mmHg drop 6-8 weeks later |
|
|
Term
| How is SLT different than ALT or LTP |
|
Definition
ALT and LTP cause permanent, scarring damage to the trabecular meshwork
SLT does not scar as much and is repeatable |
|
|
Term
| Prognosis of POAG after laser treatment |
|
Definition
still need glaucoma meds
Only keeps IOP down for about 5 years
|
|
|
Term
| Difference b/w sclerostomy and trabeculectomy |
|
Definition
Sclerostomy is a full scleral channel
Trabeculectomy is a partial scleral channel |
|
|
Term
| Name 2 post-surgical drugs that may be given to prevent scarring |
|
Definition
| 5-fluorouracil and mitomycin |
|
|
Term
| Risks involved with 5-FU and Mitomycin |
|
Definition
risk of hypotony (low pressure)
risk of wound leak (reduced healing)
risk of endophthalmitis
risk of encapsulated bleb |
|
|
Term
| 2 types of end-stage glaucoma surgery |
|
Definition
Cyclocryotherapy-permanently freezing ciliary body
Transcleral YAG laser Cryophotocoagulation-use laser to damage ciliary body epithelium |
|
|
Term
| Flow of glaucoma surgery options (from first option to end stage) |
|
Definition
ALT/SLT
Trabeculectomy
Tube shunt
Cyclocryotherapy |
|
|
Term
| Name the 4 main classifications of glaucoma |
|
Definition
Primary Open Angle
Primary Closed Angle
Secondary glaucomas
Developmental glaucomas |
|
|
Term
| What is the most common form of adult glaucoma |
|
Definition
|
|
Term
| Order the structures seen with gonioscopy starting with ciliary body |
|
Definition
Ciliary body
Scleral spur
Trabecular meshwork
Schwalbe's line |
|
|
Term
| Visibility of what structure in gonioscopy indicates an open angle |
|
Definition
|
|
Term
| Which structure obstructs the outflow of aqueous in cloased angle glaucoma |
|
Definition
|
|
Term
| Difference between pigmentary dispersion syndrome and pigmentary glaucoma |
|
Definition
Pigment accumulation in the TM
PDS=no optic neuropathy
PG=with optic neuropathy |
|
|
Term
| Rate of conversion of PDS to PG |
|
Definition
|
|
Term
| 2 theories of pathophysiology of pigmentary dispersion syndrome/glaucoma |
|
Definition
1. Abnormal iris pigment epithelium results in dispersion
2. rubbing of the iris pigment epithelium against lens or zonules results in release |
|
|
Term
| Age range of Pigmentary glaucoma |
|
Definition
|
|
Term
| PDS is most common in which race |
|
Definition
|
|
Term
| PG is more common in which gender? |
|
Definition
|
|
Term
| 2 Ocular characteristics that tend towards developing PDS earlier |
|
Definition
|
|
Term
| 3 symptoms caused by Rapid IOP elevation |
|
Definition
Pain
Intermittent blurry vision
Halos around lights |
|
|
Term
| Classic triad of diagnosis of pigmentary glaucoma |
|
Definition
Krukenberg spindle
Iris transillumination defects
Pigment deposition in the TM |
|
|
Term
| Vertical accumulation of pigment on the central corneal endothelium |
|
Definition
|
|
Term
| Location of iris transillumination defects due to pigmentary dispersion |
|
Definition
|
|
Term
| Pigment observed on or anterior to Schwalbe's line |
|
Definition
|
|
Term
| 4 locations where pigment may be found in pigmentary dispersion syndromes |
|
Definition
Anterior Iris
Corneal endothelium
Lens zonules
Lens capsule |
|
|
Term
| 2 gonioscopy findings associated with pigmentary dispersion |
|
Definition
Pigment on TM
concavity of mid-peripheral iris |
|
|
Term
| 2 causes of pigment liberation |
|
Definition
Strenuous exercise
Pupil Dilation |
|
|
Term
| 4 DDx for Pigmentary Glaucoma |
|
Definition
Exfoliation syndrome
Uveitis
Ocular melanosis
POAG with excessive pigmentation |
|
|
Term
POAG vs. PG
In which is IOP generally more difficult to control? |
|
Definition
|
|
Term
| Most common identifiable form of secondary open angle glaucoma |
|
Definition
| Pseudoexfoliation glaucoma |
|
|
Term
| Disease characterized by gray-white granular flakes depositing throughout anterior chamber accompanied by increased IOP and/or changes in VF and optic nerve |
|
Definition
| Pseudoexfoliative glaucoma |
|
|
Term
| Name 3 possible sources of pseudoexfoliation material |
|
Definition
iris pigment epithelium
ciliary epithelium
peripheral anterior lens epithelium |
|
|
Term
| Most common age of onset of PXS/PXG |
|
Definition
|
|
Term
| What ethnicity has a high rate of developing PXS/PXG |
|
Definition
|
|
Term
| Approximate rate of conversion from PXS to PXG |
|
Definition
| approx. 15% after 10 years |
|
|
Term
| Describe the 3 zones on the lens in pseudoexfolation |
|
Definition
Central Translucent Zone in pupillary area
Clear intermediate zone due to iris rubbing
Peripheral granular zone with dense deposits |
|
|
Term
| A common clinical feature of PXS due to weakened zonules |
|
Definition
|
|
Term
| PXS patients are more prone to what ocular condition |
|
Definition
|
|
Term
| Pattern of iris defects common in PXS/PXG |
|
Definition
Pupillary ruff defects,
Moth eaten in peripupillary and sphincter regions |
|
|
Term
| 3 Features of the cornea in PXS/PXG |
|
Definition
Clumps of PXM on endothelium
Krukenberg spindle
decreased endothelial cell count
|
|
|
Term
| DDx for Pseudoexfoliation |
|
Definition
Pigment dispersion
True exfoliation
Uveitis
POAG with excessive pigmentation
|
|
|
Term
| Advantage of selective laser trabeculoplasty compared to argon laser trabeculoplasty |
|
Definition
| Equal efficacy but is repeatable, ALT is not repeatable |
|
|
Term
| Increased concentration of this substance in tears and plasma has been correlated with PXG |
|
Definition
|
|
Term
| 2 substances used to reduce homocysteine concentrations in PXG |
|
Definition
|
|
Term
| Most common cause of neovascular glaucoma |
|
Definition
| RETINAL hypoxia or ischemia results in the release of angiogenic factors |
|
|
Term
| 2 clinical terms for new vessels on the iris |
|
Definition
Neovascularization of the iris (NVI)
Rubeosis irides (RI) |
|
|
Term
| Clinical term for angiogenic factor |
|
Definition
| Vascular Endothelial Growth Factor (VEGF) |
|
|
Term
|
Definition
| Development of Neovascular glaucoma following Central Retinal Vein Occlusion, usually happens 90 days after |
|
|
Term
| Name 8 disorders that predispose patients to neovascular glaucoma |
|
Definition
Central Retinal Vein Occlusion
Diabetic Retinopathy
Carotid Artery Disease
CRAO
Uveitis
Long standing retinal detachment
Intraocular tumors
Carotid cavernous fistula |
|
|
Term
| What test is used to differentiate ischemic vs. nonischemic CRVO |
|
Definition
|
|
Term
| Which disorder has the highest rate of developing neovascular glaucoma |
|
Definition
| Central Retinal VEIN Occlusion |
|
|
Term
| Which is more likely to lead to neovascular glaucoma CRVO or CRAO? |
|
Definition
|
|
Term
| Describe the earliest sign of NVI |
|
Definition
| fine, tortuous tufts of vessels on the surface of the iris |
|
|
Term
| What slit lamp magnification is needed to see early signs of NVI |
|
Definition
|
|
Term
| What needs to be done to ensure pseudoexfolation of the lens is visualized and caught? |
|
Definition
| Dilation and then examination of the lens |
|
|
Term
| Why is it important to gonioscopy in addition to SLE on diabetic patients? |
|
Definition
| neovascularization can sometimes appear in the angle before the iris/pupillary margin |
|
|
Term
| Visualizing a red flush on TM when performing gonioscopy may indicate what? |
|
Definition
| Neovascularization of the angle |
|
|
Term
| Late phase of neovascular glaucoma |
|
Definition
Fibrovascular membrane within the angle contracts, creating a peripheral anterior synechiae (PAS).
This synechiae pulls over the TM and causes angle closure |
|
|
Term
| What other sign may accompany vascular proliferation in neovascular glaucoma? |
|
Definition
|
|
Term
| DDx of Neovascular Glaucoma |
|
Definition
Any condition that causes NVI regardless of retinal condition
Post-surgical dilation of iris vessels
Uveitis (causes dilation of vessels)
Fuch's heterochromic iridocyclitis
Intraocular inflammation
Acute angle closure glaucoma
Congenital iris tufts
Lightly pigmented irides |
|
|
Term
3 Aspects of a Good Neovascular glaucoma workup
|
|
Definition
High Mag SLE
Gonioscopy
Iris/angle angiography |
|
|
Term
| Key to successful management of neovascular glaucoma |
|
Definition
|
|
Term
| 3 substances used to treat neovascular glaucoma |
|
Definition
Topical steroids (inflammation)
Anti-VEGF
IOP control meds |
|
|
Term
| 3 Procedure options to treat Neovascular glaucoma |
|
Definition
Panretinal Photocoagulation (PRP)
Panretinal Crytherapy
Filtering surgery |
|
|
Term
| When would Panretinal crytherapy be used rather than panretinal photocoagulation? |
|
Definition
| Use cryotherapy in cloudy media and when PRP has failed |
|
|
Term
| Name 2 methods that have shown to be effective when used as combination therapy for Neovascular Glaucoma |
|
Definition
Anti VEGF + PRP
PRP 1 week after ANTI-VEGF |
|
|
Term
| 4 Options for the painful blind eye with uncontrolled IOP |
|
Definition
Continued meds
cyclodestruction
Retrobulbar alcohol injection
Enucleation |
|
|
Term
| Which gender is more at risk for ACG |
|
Definition
|
|
Term
| Which refractive error is more at risk for ACG |
|
Definition
|
|
Term
| Risk for ACG increases with age until what event (which reverses the risk) |
|
Definition
|
|
Term
| 8 Clinical Features of ACG |
|
Definition
Circumferentially closed angle
peripheral anterior synechiae
posterior synechiae
Glaucomflecken
Iris torsion
Iris atrophy
Disc edema
Optic atrophy |
|
|
Term
| 2 forms of acute angle closure |
|
Definition
With pupil block
Without pupil block |
|
|
Term
| Signs & symptoms of acute angle closure glaucoma with pupil block |
|
Definition
Severe eye pain
Headache
Blurry vision
Corneal edema
narrow angle
fixed, mid-dilated pupil
IOP>40
Nausea & vomiting |
|
|
Term
| 4 Anatomic sources of iris apposition of the TM in ACG |
|
Definition
Iris
Ciliary body
Lens (phacomorphic)
Posterior to the lens (malignant glaucoma) |
|
|
Term
| Differentiate the iris configuration in ACG with pupil block vs. without pupil block |
|
Definition
With block=iris bombe (peripheral iris adheres to cornea or TM)
without block=plateau iris (last iris roll is bunched against TM) |
|
|
Term
| Iris appearance seen with gonioscopy on a plateau iris |
|
Definition
| Double hump or sine wave appearance |
|
|
Term
| What age group and gender does Plateau Iris tend to occur in? |
|
Definition
Young patients (younger than POAG)
Females |
|
|
Term
| Which anatomic abnormality is thought to correlate with plateau iris |
|
Definition
| Large or anteriorly positioned ciliary processes |
|
|
Term
| First treatment of plateau iris |
|
Definition
| Laser Peripheral Iridotomy (LPI aka PI) |
|
|
Term
| Clinical term for patients with persistent occludable angle after peripheral iridotomy has been performed |
|
Definition
|
|
Term
| Treatment for plateau iris syndrome |
|
Definition
| Laser iridoplasty-peripheral laser burns shrink iris and pull it away from angle |
|
|
Term
| Options for Iris plateau syndrome after unsuccessful laser iridoplasty |
|
Definition
Trabeculectomy
Tube-shunt |
|
|
Term
| Term for angle closure glaucoma caused by swelling of the lens which leads to a shallow anterior chamber |
|
Definition
| ACG secondary to phacomorphic glaucoma |
|
|
Term
| Term for ACG due to posterior misdirection of aqueous into vitreous, the lens-iris diaphragm is pushed forward |
|
Definition
| ACG secondary to Malignant Glaucoma |
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