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Glaucoma > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Pars plicata components

A

Ciliary muscle
Ciliary vessels
Ciliary processes

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2
Q

Aqueous composition

A

Compared to plasma:

15x more ascorbate
lower: protein, calcium, phosphorous
Vary: Na, bicarbonate

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3
Q

Path of molecule from blood to post chamber

A

Capillary basement membrane
pigmented epithelium basement membrane pigmented epithelium
nonpigmented epithelium
nonpigmented epithelium basement membrane

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4
Q

Goldmann iop equation

A

Iop = f/c + EVP

Normals
F = 2-3 uL/min
C = 0.28 uL/min/mm Hg (<0.20 abnl)
EVP = 8-12

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5
Q

Direct gonio lenses

A

Koeppe

Swan Jacobs

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6
Q

Indirect gonio lenses

A

Goldmann 3-mirror

Zeiss/posner/sussman- can do indentation

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7
Q

Normal GVF

A

60 deg nas/sup
70 deg inf
100 deg temp

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8
Q

PXG gene

A

LOXL1 (Chr 15)

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9
Q

Most common cause of Glc a/w retinoblastoma

A

NVG (75%)

Less commonly 2ndary ACG

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10
Q

Measurement of
A: outflow facility
B: EVP
C: aqueous production

A

A: tonography
B: manometry
C: fluorophotometry

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11
Q

Most decreased sensitivity in arcuate scotoma occurs in what quadrant?

A

Superotemporal

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12
Q

CIGTS

A

Newly dx’ed POAG tx’ed with trab (+-) 5FU vs medication (stepped regimen)

Primary outcome: VF loss

Results:
No diff in VF loss at 5 yrs
Va initially decreased c surg, but equalized by 4 yrs
IOP 17-18 med group, 14-15 trab 
More VS cat in trab group
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13
Q

Type of Glc a/w Down syndrome

A

Axenfeld-Rieger

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14
Q

Initial tx of pupillary block 2/2 microsherophakia

A

Cycloplegics

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15
Q

Glaucoma Laser Trial

A

ALT vs T 1/2 for POAG

Eyes with ALT 1st had lower iop and better VF/ON status than fellow eye tx’ed c timolol

Conclusion: ALT at least as effective as initial tx c timoptic

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16
Q

CNTGS

A

145 eyes randomized to obs vs tx c laser/gtts/surg (did not use beta blockers or PGAs)

Goal iop redxn 30%

12% of tx group progressed vs 35% of control, but only p adjusting for FX of cataract

Conclusions:

  • dec iop by 30% dec rate of VF loss in NTG, but rate of prog is slow and variable
  • RF for progression: migraine, female, disc heme
17
Q

Low pressure glaucoma tx study (Low GTS)

A

Compare T1/2 to a-gan in tx of NTG

Progression in 9.1% of a-gan vs 39.2% c T1/2, BUT:

  • Hi dropout rate in a-gan group
  • multiple ways of measuring progression
18
Q

EMGT

A

IOP redxn vs obs in tx of newly dx’ed OAG

Tx group: ALT + betaxolol; Ave iop redxn 25%

  • Progression in 45% tx’ed vs 62% obs
  • Each 1 mm Hg IOP lowering from baseline to 1st f/u visit (3 m.) dec risk of prog by 10%
  • inc cat in tx group
  • RF for prog: hi baseline iop, exfoliation, b/L dz, older age, disc heme
19
Q

AGIS

A

ALT vs Trab as initial surg in pts c adv OAG not controlled by medical tx.

Main outcome: VF, VA

7-yr results:

  • AA pts: ATT is best; VF defects more severe in this group
  • Caucasians: TAT is best
  • Eyes c iop <18 at all visits had almost no VF prog
  • trab inc risk of cat (74% if no comp, 104% if comp)
  • RF trab failure: young age, hi iop, DM, postoperative complications
  • RF ALT failure: young age, hi iop
  • RF blob encapsulation: males, prev ALT (not stat sig)
20
Q

OHTS

A

Meds vs obs in ocHTN

Incl criteria: iop 24-32 in one eye and 21-32 in fellow eye c normal VF and ON

Goal: iop redxn of at least 20% and target iop < 24.

Outcome: VF loss, ON damage

Results:

  • iop redxn 22.5% in tx group
  • POAG dev at 5 yrs in 4.4% of tx group vs 9.5% control
  • RF for prog: baseline iop, age, c:d, CCT
21
Q

TVT

A

Pts c failed trab OR prior CE/IOL c uncontrolled Glc (iop 18-40) on MMT randomized to trab c MMC vs BGI (350 mm)

1yr results:

  • same iop redxn in both groups (ave 12), but fewer meds required in trab group
  • failure rate 13.5% c trab vs 3.9% tube (incl persistent hypotony, re-op as failure)

3 yr:

  • both groups had no stat sig diff in IOP (~13) and # of meds (~1)
  • Failure rate 15% tube vs 30% trab
22
Q

Pres-free gtts

A

brimonidine with Purite (i.e. Alphagan-P)
timolol in gel-forming solution
preservative-free timolol maleate
travaprost without BAK (i.e. Travatan Z).

23
Q

Tx of pupillary block 2/2 subluxed lens

A

Two LPIs 180 degrees apart

24
Q 
Genes a/w:
Axenfeld-Rieger
Cong Glc
Juvenile Glc
Pxe
NTG
A 
PITX2 & FOXC1
GLC3A-C, CYP1B1
GLC1A (MYOC)
LOXL1
OPTN
25
Q

Laser settings for:

a. ALT
b. SLT

A

a. 50 micron spot, 0.1 sec duration, power 300-1000 mW

b. 400 micron spot, 3 ns duration, power 0.5-1.2 mJ

26
Q

Side effects of topical CAI

A

brinzolamide- blurry VA; dorzolamide- irritation 2/2 acidity; both can worsen endothelial decompensation in pt’s with pre-existing compromise

27
Q

Congenital Glc genes

A

1ary cong Glc (sporadic/AR): GLC3a/CYP1B1 and GLC 3b
Juvenile onset (AD): GLC1a (TIGR/MYOC)
Ant seg dysgenesis: PITX2, FOXC1
Aniridia: PAX6

28
Q

Beta blocker mechanism and side FX

A

Inhibit Na/K ATPase by dec cAMP

Dec K sensitivity, heart blk/asthma, dec HDL

29
Q

A2 agonist mechanisms and side FX

A

Dec IOP by dec EVP

Allergy, lid retrxn; avoid in kids

30
Q

Errors in TApp

A

ATR cyl/thick K/Thick mires = overestimation of IOP

WTR cyl/thin K/thin mires = underestimation of IOP

31
Q

R/B of MMC vs. 5-FU

A

5-FU
Adv: cheap, stable at room temp, dont need to dilute, greater safety margin
D/A: less effective, K epi toxicity

MMC:
Adv: greater IOP redxn, less application time
D/A: more leaks/avascular bleb/infxns, reconstitute from powder, unstable at room temp, $$$

Glaucoma (1 decks)

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