Glaucoma Flashcards
What % of pple are steroid responders and at what point does steroid induced glaucoma appear
42% and starts 2 weeks
whats swan syndrome?
hyphema from neo on the lip of an old corneal wound that bleeds
whats hemolytic glaucoma?
s/p VH, macrophages eat RBC–>clog tm
why do a PI in acute angle closure
treating the pupillary block component, make another channel for aq to flow from post chamber to ant chamber
what causes acute angle closure?
pupillary block–> causes iris to bow forward–>zips angle–>closed on gonio–>do PI to break pupillary block and
how does plateau iris cause angle closure
funny insertion of iris causes a roll of iris to block tm. On slit lamp ac will be deep centrally but will se “double hump” sign on gonio
how do you treat plateau iris?
1) peripheral pupilloplasty
2) ce
3) chronic miotics to keep iris out of angle
what causes pupillary block in an aphakic eye?
ant hyaloid face causing pupillary block
whats the unifying theme in ICE syndrome?
they all have abnormal K endo, with beaten bronze appearance and downgrowth into angle causing glaucoma
Is ICE unilateral or bilateral?
unilateral
Whats the difference between the ICE syndromes?
The appearance of the iris
Whats the other name for cogan reese syndrome?
IRIS NEVUS SYNDROME (cogan resse and iris nevus both 2 words)
Whats the exam in chandler syndrome
iris appears normal
should you do a trab in ICE?
no bc crap grows over the bleb
whats nanophthalmos?
small eye but normal structures
lens bowing forward causes what refractive shift?
myopic if lens bows forward
hyperopic if lens goes back
(its the opposite of glasses)
At what age is glaucoma considered JOAG?
if the glaucoma starts >3 yo
what are haabs striae?
horizontal lines in congenital glaucoma
whats the surgical sequence for congenital glaucoma?
1) goniotomy 2) trabeculotomy 3) trab w mmc 4) tube
is axenfeld reiger unilateral or bilateral?
bilateral
whats the inheritance pattern of axenfeld reiger?
AD
posterior embryotoxon, periumbilical skin folds, maxillary hypoplasia, microdontia, hypospadias
axenfeld reiger
whats Gillespie syndrome?
a syndrome that 2% of aniridia pts have.
Triad of aniridia, cerebellar ataxia and MR
WHat % of pts w peters have glaucoma?
50%
what % of the time is peters bilateral?
80%
When is there blunt pressure rise?
am
which beta blocker can cause heart block?
levobunolol
how does beta blocker effect cholesterol?
lowers HDL
Whats a drug that acts like ACH?
Pilocarpine
Name an indirect acting parasympathomimetic drug (ie ach-ase inhibitor)
echothiphate
name a drug that’s a combo of direct acting ach and also a ach-ase inhibitor
miostat (carbachol)
whats the 2 SE of echothiophate?
1) systemic parasympathetic stimulation
2) iris cysts in children
whats the best glaucoma med in pregnancy?
brimonidine (class B). Everything else is class C
What % of pple have success at 6 mo with ALT?
80%
Who is NOT good candidate for trab?
young
aphakic
black
previous failed trab
Does treating a pt with OHTN delay onset of glaucoma?
OHTS showed IOP reduction reduced the development of glaucoma from 9.5% to 4.4%
Does treating a pt with early glaucoma delay progression? Maybe we should just leave these pts alone?
Early manifest glaucoma trial (EMGT) showed pts treated with BETAXOLOL AND ALT has less and later progression vs. observed group (45% v 62%)
When a pt is first diagnosed with glaucoma is there a “best” way to treat the pt?
Collaborative Initial glaucoma treatment trial (CIGTS) showed med vs trab has very similar outcome at 5 years.
What did the glaucoma laser trial show? (GLT)
Timolol vs ALT as initial treatment showed ALT is just as good as timolol
My pt is failing medical therapy, should I go to ALT or trab?
AGIS showed white pts did better w trab. Black pts did better w ALT
Im doing a trab- anything I can do to increase chances for success?
5FU filtering surgery study- substantial improvement in IOP reduction with 5-FU
Does lowering IOP in pt w NTG help?
Collab NTG study- lowering IOP by 30% reduced progression from 35% to 12%
PXE gene
LOXL1
PITX2 gene
Axenfeld Reiger
TIGR-MYOC
JOAG
FOXC1 gene
Axenfeld reiger (the foxy one gets reigers from being anorexic)
whats phacoanaphylactic glaucoma?
trauma violates ant capsule–>lens proteins leak out–>glaucoma
whats the significance if 2 isopters cross on a GVF?
functional vision loss
why is 5FU a crappy choice during trabs?
causes K tox
weird HVFs- whats does frequency doubling technology stimulate, what does SWAP hvf stimulate?
FDT- Magnocellular cells of rnfl
SWAP- koniocellular cells of rnfl
“frequenting mcdonalds seems krazy”
how can you check if theres epi downgrowth on an iris?
argon laser to iris will turn white
whats the best tolerated glaucoma med around the eye?
timolol
whats GLC1A associated with
JUVENILLE glaucoma
OPTN GENE
NTG
how does GDX work?
scanning laser polarometer
measures birefrigence of the NRFL and compares it to itself in 4 quads (doesnt actually measure thickness)
what systemic med might blunt the effect of timolol?
a systemic beta blocker like atenolol
what % of pple >40 in the US have glaucoma?
2%
who gets CPC?
poor visual potential and poor surgical candidtae
what topical steroid gtts may cause iop rise?
PF and dex
pt on tricyclic antidepressant, which glaucoma med do you have to avoid
alphagan
pt w asthma and betaxolol not available, whats the next best choice?
carteolol
how do pas in plateau iris look like?
start at schwalbes and go posterior
sine wave sign
plateau iris
what kind of epidemiologic distribution is IOP?
non-Gaussian with a skew toward higher pressures
whats the deal with “matrix” visual field testing
using freq-doubling technology (tests magnocellular gang cells) and tests same number of points as standard 24-2
what G needle is used to make the sclerostomy during a tube?
23G
which glaucoma drop is most associated with dermatitis/red eye?
iopidne (apraclonidine)
what % of the time do meds help aq misdirection?
50%
which dz has lower than avg iop?
myotinic dystrophy
why is it potentially bad to do a trab with a ce at the same surgery?
bc wound healing/inflamm from ce may decr the success of the trab
