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Dr. T. Sarada M.S. Ophthalmology
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Congenital and developmental Glaucomas Without associated anomalies - Primary congenital With associated anomalies ICE syndromes Aniridia Primary glaucomas POAG PACG Secondary glaucomas Open angle Closed angle
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Clinical features Photophobia, lacrimation, blepherospasm Buphthalmos, corneal edema, descemet’s tears Blue sclera, Pathology Trabecular dysgenesis Evaluation under anaesthesia IOP, corneal Diameter, disc evaluation, gonioscopy
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buphthalmos
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Treatment Goniotomy Trabeculotomy Trabeculotomy + trabeculectomy
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Treatment Goniotomy Trabeculotomy Trabeculotomy + trabeculectomy
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Congenital and developmental Glaucomas Without associated anomalies - Primary congenital With associated anomalies ICE syndromes Aniridia Primary glaucomas POAG PACG Secondary glaucomas Open angle Closed angle
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Congenital and developmental Glaucomas Without associated anomalies - Primary congenital With associated anomalies ICE syndromes Aniridia Primary glaucomas POAG PACG Secondary glaucomas Open angle Closed angle
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Risk factors Heredity Age Myopia Diabetes Smoking Htn Thyroid dysfunction
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Etiopathogenesis Increased trabecular resistance Steroid responsiveness Clinical features Painless progressive field loss Night blindness (filed loss + delayed dark adoptation) Early loss of accommodation Complete loss of vision
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IOP Disc changes Visual field changes
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Lamellar dot sign Bayoneting sign splinter haemorrhage BARRING OF THE VESSELS
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Relative Paracentral scotoma
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Arcuate scotoma
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Ring scotoma
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Tonometry Gonioscopy Fundoscopy – Disc changes Slit-lamp examination Perimetry NFLA Provocative test
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Provocative tests Water drinking test (1 litre, IOP every 15 min, >8mm of Hg rise) Bulbar pressure test Prescoline test ( >8 mm of Hg) Caffeine test ( >8 mm of Hg) Phasing / diurnal variation test ( >8 mm of Hg)
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Treatment Medical Beta blockers (timolol) Pilocarpine CA inhibitors (dorzolamide) Prostaglandins (latanoprost) Adrenergics (apraclonidine) Organ LASER trabeculoplasty
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Surgical – Filtering surgery Trabeculectomy Non penetrating filtering surgeries Visco canolostomy Deep sclerectomy
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Rising of fornix based conjunctival flap
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Partial thickness scleral flap
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Dissection extending till limbal area
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Preperation of deep scleral block
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Excision of deep scleral block
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Surgical peripheral iridectomy
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suturing of superficial scleral flap & conjunctival flap
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Filtering bleb
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