primary open angle glaucoma

Question 1

what is primary open angle glaucoma

Answer 1

POAG is a optic neuropathy often asymmetrial charactorized by following features present in one or both eye
1-IOP>21MMHG
2-glaucomatous optic disc changes
3-Glaucomatous visual field defects
4-open and normal appearing angle
5-Absence of any secondary cause of open angle glaucoma

Question 2

Riskfactors of POAG

Answer 2

HARR FMDS
1-hereditary
2-age(common in elder)
3-race
4-retinal disease like crvo and retinitis pigmentosa
5-family history
6-myopes
7-diabete mellitus
8-steroids-6 monthsHx

Question 3

what is the mechanism of elevation

Answer 3

loss of goniocytes

Question 4

what are the symptoms

Answer 4

painless slowly progressive loss of vision usually bilateral with insidious onset
generally asymptommatic but could have night blindness,deterioration of vision in one or both eye and patient may complain of headache,eyeache and frequent change of presbyopic glasses

Question 5

signs of POAG

Answer 5

1-IOP is raised
2-galucomatous optic disc changes
3-visual field defects are present
4-angle isopen and no cause of secondary glaucoma
4-diurnal fluctuation

Question 6

DIAGNOSIS

Answer 6

RAISED IOP
CUPPING OF OPTIC DISC
VISUAL FIELD DEFECTS

Question 7

MEDICAL TREATMENT

Answer 7

PROSTAGLANDINS-FIRST LINE TREATMENT SIDE EFFECTS(conjunctival hyperemia,eyelash lenghtening,irreversible hyperpigmentation,cystoid macular edema)

2-beta blockers

3.alpha-2 agonist

4-carbonic anhydrase inhibitors

5- miotics(pilocarpine,carbacol) SE-misosis and frontal heaache

6-adrenergic drugs-DOC in pt with pulmonry disease ie epiinephrone

Question 8

combined preperations

Answer 8

XALACOM(timiolol and latanoprost)
COSOPOT(timolol and dorzolamide)
COMBIGAN(timolol and brimonidine)

Question 9

laser trabeculoplasty

Answer 9

1-Argon laser trabeculoplasty
2-Selective laser trabeculoplasty

Question 10

surgical treatment

Answer 10

Trabeculotomy(creates a fistula)
trabeculotomy by mitomycin C is considered in patients with risk factors of surgical failiure
Non penetrating glaucoma surgery(deep scelerotomy)