Glaucoma

Comprehensive Factual Review
Friday 3/21/08 - 7:00 AM to Noon
Section # F-501

Course Instructors

Module 1: Basic Concepts / General Principles in Glaucoma
Jacob Wilensky, MD

Classification, Epidemiology, Heredity

Open-angle, angle-closure, primary / secondary, Combined-mechanism

Prevelence, Risk factors – Race, gender, age, refraction

Heredity and Genetic factors, Genetic testing

Intraocular pressure and Aqueous humor dynamics

Aqueous formation, Rate, Suppression

Aqueous outflow: Trabecular (pressure dependent), Uveoscleral (pressure independent)

Episcleral venous pressure

IOP: distribution in population, factors influencing, diurnal variation, measurement of IOP

(tonography and tonometry)

Clinical Evaluation

History & biomicroscopy

Gonioscopy: Direct & Indirect

Optic Nerve Evaluation & Glaucomatous optic neuropathy

Visual field: Perimetry – Static / Kinetic. Interpretation of visual fields

Other imaging tests

Module 2: Childhood Glaucomas
Edward Sung, MD

Primary congenital or infantile glaucoma: Pathophysiology, clinical features, prognosis

Developmental glaucoma with associated ocular / systemic anamolies:

Microphthalmos, Axenfeld-Rieger syndrome, aniridia, PHPV

Other analomies & syndromes: Sturge-Weber syndrome, neurofibromatosis

Surgery for Congenital / Infantile glaucoma: Goniotomy & Trabeculatomy

Module 3: Open-Angle Glaucoma
Thasarat Vajaranant, MD

POAG: clinical features, associated disorders (myopia, DM)

OAG without elevated IOP (Normal-tension glaucoma)

Glaucoma suspect

Secondary open-angle glaucoma – PXF syndrome, Pigmentary glaucoma, Lens-induced (phacolytic)

Intraocular tumors

Posner-Schlossman syndrome, Fuch’s heterochromic iridocyclitis

Elevated episcleral venous pressure

Accidental & surgical trauma – hyphema, ghost cell, angle recession

Schwartz’s syndrome

Corticosteriod-induced glaucoma

Relevent clinical trials: OHTS, EMGT, CIGTS

Module 4: Angle-closure glaucoma

Thasarat Vajaranant, MD

Pathogenesis & pathophysiology: with / without pupillary block, lens / iris- induced

Primary angle closure: Risk factors. Acute / Subacute / Chronic angle closure, plateau iris

Secondary angle closure with pupillary block:

Lens-induced: phacomorphic, ectopia lentis, aphakic / pseudophakic

Secondary angle closure without pupillary block:

NVG, ICE syndromes, Tumors, aqueous misdirection, nanophthalmos, drug-induced

Module 5: Medical / Surgical Management of Glaucoma
Jacob Wilensky, MD

Medical management of glaucoma

Medical agents: Beta blockers, Parasympathomimetic agents, CAI, Adrenergic agonists, PG analogs

General approach to medical treatment

Surgical therapy for glaucoma

Surgery for Open-angle glaucoma:

Laser trabeculoplasty. ALT / SLT. Indications, results & follow-up, Glaucoma Laser trial (GLT).

Incisional surgery: Trabeculectomy technique, antifibrotic agents, flap management

Full-thickness sclerostomy

Combined cataract and filtering surgery

Surgery for Open-angle glaucoma:

Laser iridectomy, Laser Gonioplasty, Incisional surgeries

Other procedures to lower IOP:

Glaucoma tube shunt surgery

Ciliary body ablation procedures

Cyclodialysis

Nonpenetrating Glaucoma surgery