Glaucoma Disease PPT | Glaucoma Treatment | Malignant Glaucoma | Signs of Glaucoma | Treatment for Glaucoma: SlideWorld Medical PPT Search Engine

Malignant glaucoma diagnosis and management

Rating :

Rate It:

Send This

Download

Comment

Favourite

more

Post To:

Facebook

Twitter

Digg

Delicious

more share options

There is no comments now for this Slide.

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

1 Favorites

MBMK, favourited this 3 Months ago.

Notes

Show Notes

Slide 1 :

Malignant glaucoma diagnosis and management Dr Diana Melinte Dumitrica SCUMC-Bucharest Romania Email: dianamelinte_17@yahoo.com

Slide 2 :

1869 Von Graefe Malignanat glaucoma = clinical shallow anterior chamber associated with raised intraocular pressure in the presence of a patent periferic iridectomy for acute angle closure glaucoma

Slide 3 :

Definition European Glaucoma Society; II edition Secondary angle closure glaucoma with ‘’posterior’’ pushing mechanism, without pupillary block, caused by the ciliary body and iris rotating forward Other terms: aqueous misdirection glaucoma ciliary block cilio-lenticular block malignant glaucoma posterior aqueous diversion syndrom

Slide 4 :

Incidence 2-4% of eyes undergoing surgery for angle closure glaucoma; more frequently if the angle in closed before surgery may occur at any time following surgery Causes: after filtrating surgery in phakic angle closure eye: spontanous or at the cessation of cycloplegic treatment after cataract surgery at the begining of the miotic treatment after laser iridotomy laser capsulotomy Nd-Yag cyclophotocoagulation hypermetropia intravitrean triamcinolone central retinal vein occlusion inflammations,trauma

Slide 5 :

Pathophysiology The exact mechanism remains unclear The misdirection of aqueous posterior towards the vitreous (either into or around) ? ? volume of the vitreous ? anterior pushing of irido-cristalinian diaphragm ? shallow of the anterior chamber + ? IOP Causes: shallow anterior chamber angle closure the increase of the volume of the cilliary body and the inflammation anterior rotation of the cilliary body anterior movement of the irido-cristalinian diaphragm by miotics

Slide 6 :

Misdirection of the aqueous Posterior towards the vitreous Posterior and around the lens (perilenticular misdirection) Posterior of the iridocapsular diaphragm or IOL (retrocapsular misdirection)

Slide 7 :

Diagnosis A patien with narrow angle / primary angle closure glaucoma / acute angle closure glaucoma following a filtration surgery ? VA Red eye with pain Malaise like in acut angle closure glaucoma Raised IOP (sometimes can be normal ) Accelerating factors: - the end of the cycloplegic treatment - the begining of the miotic treatment

Slide 8 :

Slit-lamp examination Negative Seidel test Shallow anterior chamber central and periferic Anterior movement of irido-cristalinian diaphragm or anterior hialoid in phak eyes Patent periferic iridectomy No filtration bleb Clear spaces within the vitreous Positive Seidel test Malignant glaucoma

Slide 9 :

Malignant glaucoma: cilio-lenticular block Malignant glaucoma: cilio-vitrean block

Slide 10 :

Positive diagnosis Clinical examination The key = raiser IOP + shallow anterior chamber

Slide 11 :

Investigationes Ultrasound A scan: axial length Ultrasound B scan: exclude other pathologies Ultrasound biomicroscoscopy

Slide 12 :

Ultrasound biomicroscopy Confirm the diagnosis by the visualitation of the anterior segment structures: Irido-corneal touch Appositional angle closure Anterior rotation of the ciliary body Apposition to the iris

Slide 13 :

Differential diagnosis Pupilary block Suprachoroidian hemoragie Choroidal effusion syndrom Pupillary block Malignant glaucoma

Slide 14 :

Evolution Corneal decompensation by irido-cristalinian touch with endothelium damage Peripheral anterior synechies Posterior synechies Cataract Optic nerve damages by rised IOP Decrees of visual acuity

Slide 15 :

Treatment Medical treatment – first step (good results in 50% of cases) - Cycloplegia with atropin 1%x 4-6/zi - Mydriasis with phenilephrin 2,5%x 4-6/zi Mechanism of action posterior push of the irido-cristalinian diaphragm cilliary muscles relaxation Long time treatment with atropin is required because of the recurences (sometime for several years) - ß blockers, AIC,a agonists - Hyperosmotics agents: Glicerol (po), Manitol (2g/kgcorp iv) !!! Miotics are contraindicated !!!

Slide 16 :

Medical treatment Medical treatment has to be tried for 2-4 days with the observation of the evolution If everything is ok – no need of hypotensors Cyloplegia has to be for long periods of time

Slide 17 :

Laser treatment Laser Argon throught periferic iridectomy - decrease the vlolume of cilliary body Laser Nd Yag – capsulotomy and/or anterior hialoidotomy

Slide 18 :

Surgery Indication: no succes in medical or laser treatment corneo-cristalinian contact Pars plana vitrectomy ± lensectomy Lensectomy: - corneal oedema - dens cataract - no anterior chamber formation during vitrectomy Pseudophak: vitrectomy + anterior hialoidotomy Aspiration of the fluid from the vitreous with an 20 gauge needle

Slide 19 :

The prognosis depends of the severity and the anterior situation Malignant glaucoma remains a most difficult clinical problem in terms of diagnosis and management The precise mechanism remains unclear and that why the management is controversial

Slide 20 :

Bibliography M Yanoff, JS Duker – Ophthalmology (second edition) European Glaucoma Society – Terminology and guidelines for glaucoma (second edition) British Journal of Ophthalmology 1997;81:163-167 ‘’Malignant glaucoma and its management’’ S Ruben, J Tsai, R Hitchings JJ Kanski – Clinical Ophthalmology E-medicine 2007 ‘’Malignant glaucoma’’ Mauricio E Pons Benjamin F Boyd, Maurice Luntz, Samuel Boyd - Innovations in the glaucomas 2002 American Academy of Ophthalmology – Glaucoma (2005)

	dianamelinte_17@yahoo.com 1 Years ago. Category: Ophthalmology

Tags:	Ophthalmology

Embed:
889 Views, 1 favourite
PowerPoint Presentation on Malignant glaucoma diagnosis and management or PowerPoint Presentation o more PowerPoint Presentation on Malignant glaucoma diagnosis and management or PowerPoint Presentation on less

SWINE Flu

Why do women live longer then men? Humor

History of Medicine

Yoga and Medicine

How to be a Successful Interventional Fellow size 50 MB

Cardiac Pathology

Hypertension: New Concepts, Guidelines, and Clinical Management

Diabetes Pathology

Medical Powerpoint Templates
(20% Dicsount For Student/Faculty)