Scribd Logo
Upload

Welcome to Scribd!

  • 18 views

    POAG

    Uploaded by

    Vimal 2000
    Primary open angle glaucoma (POAG) is the second leading cause of blindness worldwide. It is characterized by progressive optic nerve damage and visual field loss due to increased intraocular pressure (IOP) from impaired outflow of aqueous humor through the trabecular meshwork. The IOP increase is usually asymptomatic initially, with patients later experiencing vision loss starting with the peripheral visual field. Diagnosis involves measuring elevated IOP, examining the optic disc for cupping and nerve fiber layer loss, and testing for visual field defects. Treatment aims to lower IOP and prevent further nerve damage through topical eye drops, laser trabeculoplasty, or filtration surgery if drops are insufficient.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    POAG

    Uploaded by

    Vimal 2000
    18 views23 pages
    Primary open angle glaucoma (POAG) is the second leading cause of blindness worldwide. It is characterized by progressive optic nerve damage and visual field loss due to increased intraocular pressure (IOP) from impaired outflow of aqueous humor through the trabecular meshwork. The IOP increase is usually asymptomatic initially, with patients later experiencing vision loss starting with the peripheral visual field. Diagnosis involves measuring elevated IOP, examining the optic disc for cupping and nerve fiber layer loss, and testing for visual field defects. Treatment aims to lower IOP and prevent further nerve damage through topical eye drops, laser trabeculoplasty, or filtration surgery if drops are insufficient.

    Original Description:

    Primary open angle glaucoma

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Primary open angle glaucoma (POAG) is the second leading cause of blindness worldwide. It is characterized by progressive optic nerve damage and visual field loss due to increased intraocular pressure (IOP) from impaired outflow of aqueous humor through the trabecular meshwork. The IOP increase is usually asymptomatic initially, with patients later experiencing vision loss starting with the peripheral visual field. Diagnosis involves measuring elevated IOP, examining the optic disc for cupping and nerve fiber layer loss, and testing for visual field defects. Treatment aims to lower IOP and prevent further nerve damage through topical eye drops, laser trabeculoplasty, or filtration surgery if drops are insufficient.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    18 views23 pages

    POAG

    Uploaded by

    Vimal 2000
    Primary open angle glaucoma (POAG) is the second leading cause of blindness worldwide. It is characterized by progressive optic nerve damage and visual field loss due to increased intraocular pressure (IOP) from impaired outflow of aqueous humor through the trabecular meshwork. The IOP increase is usually asymptomatic initially, with patients later experiencing vision loss starting with the peripheral visual field. Diagnosis involves measuring elevated IOP, examining the optic disc for cupping and nerve fiber layer loss, and testing for visual field defects. Treatment aims to lower IOP and prevent further nerve damage through topical eye drops, laser trabeculoplasty, or filtration surgery if drops are insufficient.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    Primary open angle glaucoma

    Dharanitharan M
    Roll no:19
    What is glaucoma ?
    • The term glaucoma is derived from the
    Greek word “glaukos” meaning “gray blue”
    • Is the second leading cause of blindness
    worldwide
    • The third most common cause of blindness
    in India
    • Not reversible

    2
    Definition of POAG
    • Chronic, progressive optic neuropathy
    characterised by morphological changes at
    the optic nerve head and retinal nerve fibre
    layer leading to characteristic visual field
    changes, in the absence of other ocular
    diseases or congenital anomalies (with or
    without a raised IOP)

    3
    Pathogenesis of POAG
    • Decrease in aqueous outflow facility due to
    increased resistance to outflow leads to rise
    in IOP
    • Two theories of axonal loss in optic disc
    • 1. Mechanical: Increased IOP — blockage
    of axoplasmic flow— optic atrophy
    2. Vascular: Optic disc ischaemia with
    defective autoregulation of blood vessels—
    optic atrophy
    4
    Aqueous humor outflow

    5
    Major amount of aqueous humor leaves the
    eye by

    BULK FLUID FLOW

    i.e. fluid flows along normal pressure


    gradient through non-energy dependent
    process

    6
    Ciliary processes
    ↓
    Aqueous Humor in PC
    ↓
    through pupil
    ↓
    Anterior Chamber

    7
    Trabeculo-canalicular outflow

    *It is the main outlet for aqueous from the AC


    *70-90% of total aqueous is drained by this route
    UNCONVENTIONAL
    OUTFLOW

    *responsible for 10-25% of total aqueous outflow


    UVEO-SCLERAL OUTFLOW

    10
    Trans-corneal outflow
    - Aqueous humor from anterior chamber
    goes into tear film through cornea.
    - Very little aqueous passes through this
    pathway.
    - Total volume of fluid transferred is limited
    by high hydraulic resistance of the cornea.

    11
    Clinical features of POAG
    Symptoms
    •Usually asymptomatic in early cases
    •Mild headache and eye ache
    •Frequent changes in presbyopic glasses
    •Delayed dark adaptation
    •Loss of peripheral vision
    •Loss of central vision(late cases)

    12
    Signs of POAG
    • Normal anterior segment
    • Pupil reaction to light may be sluggish(in
    advanced cases only)
    • Elevated IOP(More than 21 mm Hg) with
    diurnal variation more than 5-8 mmHg
    • Optic disc changes (Progressive,
    asymmetric)
    • Visual field defects
    13
    14
    Optic disc changes in glaucoma
    • Early changes
    o Retinal nerve fibre layer atrophy
    o Vertically oval cup
    o Asymmetry of the cups(More than 0.2
    difference)
    o Large cup(CD more than 0.6)
    o Splinter haemorrhages

    15
    Visual field defects in glaucoma
    • Arcuate nerve fibres in the superior and
    inferior temporal portions of the optic disc:
    Most sensitive to damage
    • Macular fibres : Most resistant to damage

    CENTRAL VISION IS PRESERVED TILL


    THE LAST IN GLAUCOMA

    16
    Diagnostic work up/Investigations

    • Tonometry
    • Goniscopy: Open angles
    • Perimetry: To detect visual field defects
    • Slit lamp examination: To rule out causes
    of secondary open angle glaucoma
    • Fundus examination to document optic
    disc changes
    • Diurnal variation testing
    • Provocative testing: Water drinking test
    17
    Management of POAG
    • Therapeutic choices

    ❑ Medical therapy

    ❑ Argon/Diode Laser Trabeculoplasty

    ❑ Filtration surgery

    18
    Topical drugs used for POAG therapy
    • Prostaglandin/Prostamides
    Latanoprost, Bimatoprost, Travoprost
    • Beta blockers
    Timolol maleate, Betaxolol
    • Carbonic anhydrase inhibitors
    Dorzolamide, Brinzolamide
    • Sympathomimetics
    Brimonidine, Apraclonidine
    • Parasmpathomimetics
    19
    Pilocarpine
    Systemic drugs used for POAG therapy

    • Used rarely, for short term control of IOP


    • Oral carbonic anhydrase inhibitors
    Acetazolamide, Methazolamide

    20
    Laser treatment
    • Indications
    Target IOP not achieved with medical
    therapy
    Non compliance of medical therapy

    Argon/ Diode Laser Trabeculoplasty (ALT)


    Selective Laser Trabeculoplasty (SLT)

    21
    Surgical therapy
    • Filtration surgery : Trabeculectomy
    • Modified trabeculectomy :
    Use of antifibrotic agents
    Mitomycin/5FU
    • Aqueous drainage devices:
    Ahmed glaucoma valve

    In cases with no/poor visual potential:


    Cycloablative therapy with laser/cryo- Last
    22
    resort
    THANK YOU

    23

    You might also like