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Glaucoma > Secondary glaucoma > Flashcards

Secondary glaucoma Flashcards

1
Q

What is the prevelence of Pigment dispersion syndrome in the caucasian population?

A

2.5%

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2
Q

What risk factors are there for developing PDS?

A
  1. Caucasian Male
  2. Myopia (80%+)
  3. Young (30-40yr old)
  4. No genetic basis
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3
Q

What are the clinical features of PDS?

A
  1. Very deep anteror chambers
  2. Spoke like iris transillumination in approx 70% of patients
  3. Kruckenberg’s spindle - pigment cells in A/C that congregate on endothelium
  4. Pigment deposition on the internal structures including anterior iris, lens surface and trab meshwork
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4
Q

What is different about the anatomy in PDS?

A

Mid peripheral iris concavitity (100%)

Iris-ciliary processes (75%) small attachment from peripheral iris to

Irido-zonular contact (25%)

Detachment of zonula hyaloid membrane - increase risk of RD

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5
Q

What is the 5 year and 15 year risk of developing pigmentary glaucoma if you suffer with PDS?

A

10% at 5 years

15% at 15 years

An IOP over 21mmHg at diagnosis increases the risk

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6
Q

What is the mechanism by which PDS causes glaucoma?

A
  1. Mechanical rubbing of mi-peripheral iris against zonules and anterior capsule during pupil size changes
  2. Melanin released from iris pigment epithelium
  3. Pigment cells circulate in aqueous and are deposited in A/C
  4. Macrophages and pigment reduce outflow via trab meshwork
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7
Q

What percentage of XFS patients have raised IOP

A

25%

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8
Q

What % of patients with high IOPs and XFS will have secondary glaucoma?

A

33%

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9
Q

How much more likely is a patient with high IOPs and XFS to convert to GON than someone with simple OHT?

A

Twice as likely

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10
Q

What is the prevalence of XFS in the over 40s in the UK?

A

5%

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11
Q

What is the mechanism behind XFS?

A

It is an ischaemic disorder.

Poor blood flow to the iris results in atrophy

Combination of amyloid material and pigment gets deposited on trab meshwork blocking outflow

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12
Q

What are the clinical signs of XFS?

A
  1. Iris atrophy
  2. White amyloid material deposited on internal structures of AC particularly on the anterior lens surface. Appears as a Bull’s eye ring on dilation
  3. Associated with zonule weakness (can often see wobbling of iris on slit lamp)
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13
Q

What systemic manifestations of XFS are there?

A
  1. Hypertension
  2. Strokes
  3. TIA
  4. MI
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14
Q

What is the overall conversion of XFS to glaucoma?

A

30-70%

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15
Q

What are the risk factors in the development of XFS?

A

Northern latitudes (+ Navaho Indians)

Genetic (LOXL1 gene more common with XFS)

Age (doubles every decade from age of 50yrs)

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16
Q

What is XFS?

A

Production and progressive accumulation of a fibrillar, proteinaceous, extracellular material.

Glaucoma (6 decks)

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