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Glaucoma > Lecture 7 - NTG and Secondary OAG > Flashcards

Lecture 7 - NTG and Secondary OAG Flashcards

1
Q

Authorities have suggested that local _________ factors play an important role in NTG

A

Vascular

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2
Q

What four features are there a higher prevalance in NTG?

A

Acrynomn: CARI

Coagulopathies
Autoimmune Disorder
Raynaud Phenomena
Ischemic vascular disease

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3
Q

True or False. NTG progression will always be decreased when lowering IOP?

A

False. There are instances where progression will occur.

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4
Q

IOP findings for OD: 22mmHg and OS: 26mmHg. Which eye will be effected the most or will they be effected equally

A

OS will. The eye with the higher IOP will be more effected.

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5
Q

When the CNTGS study was conducted, reduction of IOP by ___% reduced the rate from 35% to ___% confirming a clear role of IOP

A

30% and 12% for the latter

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6
Q

VF loss progression of NTG tends to be ____

A

slow

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7
Q

A pt diagnosed with NTG will find their visual field loss to be in which region the most?

A

Closer to fixation

VF are usually focal, deeper and central

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8
Q

What is the most common type of VF loss, Arcuate or Paracentral scotoma?

A

Paracentral Scotoma

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9
Q

What are the two region of the rim that will show thinning the most with a pt with NTG? There are two answers.

A

Inferiorly and Inferiotemporally

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10
Q

What are the 2 types of Optic disc appearance of NTG?

A
  1. Senile sclerotic group
    - Shallow
    - Saucer like sloping of NRR
  2. Focal ischemic
    - Deep focal polar notching in the neuroretinal rim
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11
Q

What are the 5 glaucomatous disc classifications?

A
  1. Focal
  2. Myopic
  3. Senile Sclerotic
  4. Concentric cup enlargement
  5. Advanced
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12
Q

What are 2 benefits of using Diurnal IOP?

A
  1. Determine IOP peak

2. Establishing target IOP

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13
Q

Calcium deposits go into the vitreous and as the calcium is being pushed out, it crushses the NFL. Is this considered glaucomatous?

A

No.

Dr. Davey used this analogy. Slide 17 from lecture 7

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14
Q

What are 2 methods used for diagnostic evaluation for NTG?

A
  1. Repeated IOP measurements at various intervals

2. Gonio - rule out angle closure, recession or evidence or previous ocular inflammation

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15
Q

What are 3 rare atypical cases where structure and function don’t relate?

A
  1. Auscultation and palpatation of the carotid arteries
  2. Focus on blood flow
  3. Post chiasmal investigation using CT and MRI
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16
Q

What are the 4 types of criteria for Pigment dispersion syndrome?

A
  1. Pigment deposits on the endothelium
  2. Pigments on the TM
  3. Lens periphery
  4. Midperipheral transillumination defects
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17
Q

What are 4 clinical appearances in Secondary OAG?

A
  1. Midperipheral iris is concave bowing towards the zonular fibers
  2. Pigment deposits can be seen on zonules
  3. Does not universally develop glaucoma
  4. Common in white males with myopia between 20 to 50
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18
Q

After ______ pigment maybe release into the AH.

A

excercise

19
Q

What are the 3 types of open angle lens induced glaucoma?

A
  1. Phacolytic - leakage of lens protein through capsule of a hypermature lens (rare)
  2. Lens particles
  3. Phacoanaphylaxis
20
Q

What type of cells in the body can cause plugging of the TM?

A

Macrophages

21
Q

In lens induced glaucoma, you may see flare without KP’s. What are 2 hallmarks you may see associated with them?

A

Mutton fat KP and Fine particle (granulomatous)

22
Q

After how long can lens particle glaucoma ocur when cataract extraction has occurred?

A

Within weeks.

Note: Extraction may occur months or year later

23
Q

What type of edema can occur with lens particle glaucoma?

A

Microcystic corneal

24
Q

What type of synechiae may develop over time when lens article glaucoma has occurred?

A

Posterior synechiae

25
Q

What is Phacoanaphylaxis?

A
  1. Pt becomes sensitized to their own lens protein following cataract extraction or penetratin trauma
  2. Granulomatous inflmmation
  3. KP present
  4. Moderate anterior chamber reaction
  5. Rare
26
Q

What are 3 features that may occur during phacoanaphylaxis?

A
  1. Low grade vitritis
  2. Syncheial formation
  3. Residual lens material in anterior chamber
27
Q

What high risk health problem leads to neovascularization of the angle?

A

Diabetes

Note: Fibrous particles may occur during neo of the angle

28
Q

What type of melonomas and tumors may cause secondary closure glaucoma?

A
  1. Choroidal melanomas
  2. Retinal Tumors
  3. Choroidal Tumors
29
Q

What is a common sign in Ocular inflammation and Secondary OAG?

A

Elevated episcleral venous pressure

30
Q

What are the sign of Elevated episcleral venous pressure?

A
  1. Chronic red eye
  2. History of head trauma (carotid cavernous fistula or dural fistula)
  3. Dilated episcleral veins
  4. Unilateral or Bilateral
  5. Blood in the Schlemm’s canal
31
Q

What two major issues may occur if there is an increase in widening of angle recession?

A

Scarring and increase in IOP

32
Q

True or False. A short term corticosteroid user will induce glaucoma?

A

False. Individual must be a PROLONGED user

Note: The induced glaucoma will show a form of POAG

33
Q

What is the main area impacted when induced glaucoma has been formed due to corticosteroid usage?

A

Aqueous outflow in the TM

34
Q

What type steroids have a high chance of raising IOP compared to other steroids?

A

Dexamethosone and Prednisolone

35
Q

What type of steroid will give you the highest IOP spike post surgery?

A

Durazol

Usually requires 2 weeks to occur

36
Q

If you have an increase in IOP, with a corticosteroid user, what drugs should you use and which one will cause inflammation?

A

Use: CAI’s, Beta Blockers and Alpha Antagonist (these lower IOP)

Do not use: Prostaglandins - induce inflammation

37
Q

What are 2 mechanism of neovascular glaucoma?

A
  1. Contraction of an inflammatory, hemmorrhagic or vascular membrane band or exudate in the angle leading to PAS
  2. Forward displacement of the iris lens diaphragm often accompanied by swelling and anterior rotation of CB
38
Q

What are the 2 common health risk reasons for angle closure disorders?

A
  1. DM

2. Central Retinal Vein Occlusion

39
Q

Corneal endothelium causes what 3 variable problems?

A
  1. Iris Atrophy (progressive iris atrophy)
  2. Secondary Angle Closure
  3. Corneal Edema (chandler syndrome, cogan reese)
40
Q

What are two signs of chandler syndrome?

A
  1. “hammer silver” endothelial changes

2. Edema, which may cause halos

41
Q

What is a characteristic of ICE syndrome?

A

High peripheral anterior synechiae

Note: 50% of ICE cases develop glaucoma. Pain and decrease VA will occur.

42
Q

What are two signs of Cogan reese syndrome?

A
  1. Diffuse iris nevus

2. Pedunclated iris nodules

43
Q

What are three signs of Progressive iris atrophy

A
  1. Progressive stromal iris atrophy
  2. Broad based PAS
  3. Displacement of pupil towards PAS

Glaucoma (7 decks)

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