POAG Flashcards
Which of the following are universally accepted risk factors for POAG?
diabetes, myopia, hypertension, low ocular perfusion pressure, increasing age
myopia, low ocular perfusion pressure, increasing age
describe the two subtypes of normal tension glaucoma.
senile sclerotic: shallow, pale, sloping neuroretinal rim (primarily seen in older patients with vascular diease)
focal ischemic: deep, focal notching of the neuroretinal rim
how do the visual field defects in normal tension glaucoma tend to differ from those in POAG?
more focal, deeper, and closer to fixation, especially early in disease
what exam finding is more common in normal tension glaucoma than POAG?
disc hemorrhage
What was the patient population’s IOP range in OHTS? What percentage of patients in the treated and non-treated groups progressed to glaucoma at 5 years? What IOP decrease was achieved in the treatment group?
24-32 IOP range
- 4% treated, 9.5% non-treated at 5 years
- 5% IOP decrease with treatment
What was the most significant finding at the 13 year OHTS follow-up?
At 7.5 years, all patients in the control arm began receiving treatment. Then, at 13 years, the risk of glaucoma in the originally treated v originally nontreated group was 16% and 22%, respectively. This showed that there was no further divergence in the two arms, indicating that it may be safe to delay treatment in OHTN patients, especially those who are low risk.
Differentiate between pigment dispersion syndrome and pseudoexfoliation with regards to the following:
- patient population
- iris findings
- other anterior segment findings
- risk for glaucoma for PDS
- causative gene and defective protein for PSeudo X
- Problems during physical activity or surgery?
- PDS: white, myopic males 20-50 years old. Pseudo X: generally older than 70
- PDS: peripheral TIDs and concave mid-peripheal iris which bows posteriorly. Pseudo X: exfoliative material at pupillary margin
- PDS: pigment on cornea (Krukenberg spindle) and anterior lens capsule (Zentmeyer line). Pseudo X: targetlike pattern of fibrillar material on anterior lens capsule
- 25-50%
- LOXL1; elastin
- PDS: increased IOP w/ exercise. Pseudo X: zonular weakness
Besides slit lamp findgins, name other differences in presentation and disease course between POAG and pseudoexfoliation.
Pseudo X can be unilateral or markedly asymmetrical, with higher IOP and greater diurnal fluctuations, and overall worse prognosis. Laser trabeculoplasty can be very effective but may not last as long compared to POAG.
Name the subset of glaucoma associated with:
- hemoglobin-laden macrophages clogging TM
- melanin-laden macrophages clogging TM
- lens protein-laden macrophages clogging TM
- photoreceptor outer segments clogging TM
- devitalized RBCs clogging TM
- Recurrent bouts of markedly increased IOP and low-grade AC inflammation
- heterochromia and unilateral AC inflammation with small, stellate KP and PSC
- residual lens cortex after cataract surgery blocking TM and causing inflammation
- granulomatous inflammation secondary to ruptured lens capsule
- hemolytic glaucoma
- melanomalytic glaucoma
- phacolytic glaucoma
- Schwartz-Matsuo syndrome
- ghost cell glaucoma
- Posner-Schlossman syndrome (glaucomatocyclitic crisis)
- Fuchs heterochromic iridocyclitis
- lens particle glaucoma
- phacoantigenic glaucoma
Elderly patient with history of poor vision but sudden onset of pain, redness, blurring. Exam reveals high IOP with microcystic corneal edema, prominent cell and flare, and open angles. Diagnosis and treatment?
phacolytic glaucoma. steroids and aqueous suppressants temporize, but cataract surgery is curative.
What slit lamp finding helps distinguish phacolytic glaucoma from phacoantigenic glaucoma?
KP in phacoantigenic glaucoma, not in phacolytic
Your patient is 3 weeks after cataract surgery but has persistent AC cell, increased IOP, and corneal edema despite treatment with predforte QID. What should you do next?
gonio to look for retained lens particle
what is the most common mechanism of glaucoma in primary or metastatic tumors of the ciliary body?
direct invasion of the angle
name 7 causes of anterior chamber inflammation associated with elevated IOP
HSV keratouveitis, zoster iridocyclitis, Posner-Schlossman syndrome, Fuchs heterochromic iridocyclitis, toxoplasmosis, pars planitis, JIA
suggested infectious causes that may be linked to Posner-Schlossman syndrome and Fuchs heterochromic iridocyclitis?
PS: CMV or HSV
Fuchs: rubella
