Topic

#Glaucoma

17 articles

Articles 1 Apr 2021 17 min read

Evaluation of The Optic Nerve Head in Glaucoma

Introduction The diagnosis of primary open-angle glaucoma is based on the triad of increased intraocular pressure, visual field changes and optic nerve head changes. Apart from the glaucomatous changes in the optic nerve head, the other two factors in isolation lack diagnostic sensitivity. In fact, studies have shown that careful evaluation of the optic nerve head has high specificity and that an experienced observer may be better in distinguishing a normal from a glaucomatous disc as compared to any other technology, like the HRT or OCT.[1-3] IOP can be normal in 50% of patients of glaucoma.[4] Studies by Quigley et al have shown that up to 40% of the axons could be lost before a visual field defect develops on Goldmann perimetry and that 20% of axons are lost before a 5 db loss is detected on standard automated perimetry.[5] So to pick up early or pre-perimetric glaucoma, in the absence of imaging, a sound knowledge of assessment of optic nerve head changes in glaucoma is imperative.

Dr. Sahebaan Sethi
Articles 1 Apr 2021 3 min read

Five Things You Should Know About Intracameral Bimatoprost Sustained Release Implant

The Implant Durysta (ALLERGAN) is the first-ever intracameral sustained-release bimatoprost implant. The glaucoma treatment paradigm has shifted towards earlier intervention and targeting the actual pathology. The main problem one faces with glaucoma management is compliance with the medications. The intracameral bimatoprost addresses the problem satisfactorily. Durysta, a 10-microgram bimatoprost implant, becomes the first biodegradable, intracameral sustained release implant indicated to reduce Intraocular pressure (IOP). It is hard for patients to maintain quality of life while being on topical anti-glaucoma medications – The Intracameral Bimatoprost makes it possible. Administration of the Implant Durysta is a rod-like implant preloaded within a sterile applicator with a 28-gauge needle tip. The needle is inserted under an aseptic condition in the anterior chamber and then with the press of a trigger button implant is released. After the implantation, the needle is removed and the

Dr. Tamonash Basu
Articles 1 Apr 2021 18 min read

A Postgraduate's Guide To Tonometry

Tonometry is the procedure for the measurement of intraocular pressure. It is the most important risk factor for the development and progression of glaucoma. It is the only factor that can be treated and modified in the management of glaucoma. Therefore, the need for accurate and reproducible measurement of IOP is of utmost importance. Clinical measurement of IOP has undergone several technical advances from the initial digital tension measurements, through indentation tonometry, to applanation tonometry and non-contact tonometry. The current gold standard for the measurement of IOP is the Goldmann applanation tonometer. Tonometer in which the IOP is negligibly raised during measurements, for example less than 5%, are termed low-displacement tonometer. Tonometer that displace a large volume of fluid and consequently raise IOP significantly are termed high-displacement tonometer. Classification and Types of Tonometers are shown in Flowcharts 1 & 2. Classification of Tonometer 1 Classifi

Dr. Vidya Chelerkar · Dr. Mrunall Borrse
Articles 1 Apr 2021 13 min read

Glaucoma in Pseudophakia And Aphakia

Glaucoma in pseudophakia and aphakia is secondary glaucoma in which intraocular pressure (IOP) is elevated following cataract removal. This diagnosis is given only if there was no glaucoma prior to cataract removal.[1] The terms aphakic and pseudophakic glaucoma have been previously used in literature. Currently, this terminology is not preferred. Glaucoma in pseudophakia and aphakia refer to conditions that cause increased intraocular pressure (IOP) soon after surgery as well as to those conditions that occur much later.[2] Epidemiology : Depending on the studies, the estimate for the incidence of glaucoma post-cataract surgery varies widely. In patients with aphakia, chronic glaucoma post-cataract surgery was found to be less prevalent at 3% than a transient increase in pressure with varying percentages of pressure rise post-cataract surgery [3]. Other sources report the incidence of 5-41%[4]. In patients with pseudophakia, the incidence of IOP rise went down with an advent of the ex

Dr. Aishwarya R. Mulay
Articles 1 Apr 2021 3 min read

Five things you should know about Micropulse LASER in Glaucoma Management

Glaucoma is a leading cause of irreversible blindness worldwide, with more than 70 million people affected. Traditionally treatment options include topical medications, laser trabeculoplasty, incisional surgeries, glaucoma drainage implants (GDD), and cycloablative procedures. GDD and ciliary body destruction is generally reserved for refractory or end-stage glaucoma in eyes with poor visual potential. Transscleral cyclophotocoagulation (TSCPC) Transscleral cyclophotocoagulation (TSCPC) is a cyclodestructive procedure designed to target the melanin in the pigmented ciliary body epithelium, thereby decreasing the rate of aqueous humor production. Numerous studies have confirmed the IOP-lowering ability of TSCPC and also reported the risk of developing serious complications with this procedure, such as persistent ocular inflammation, vision loss, hypotony, phthisis bulbi, and rarely sympathetic ophthalmia. Therefore, TSCPC, which conventionally uses the continuous-wave diode laser, has b

Dr. Murali Ariga
Articles 1 Apr 2021 14 min read

Valved Drainage Devices for Pediatric Glaucoma

Introduction Pediatric glaucoma includes a wide variety of conditions that result in elevated intraocular pressure and optic nerve damage, ranging from primary congenital glaucoma since birth to developmental glaucoma associated with other diseases and acquired glaucoma secondary to multiple causes. Depending on the age of the patient, it presents with particular features and circumstances that need to be taken into account and frequently require surgical intervention. Glaucoma drainage implant surgery has a definitive role in managing infants and other children with glaucoma refractory to angle surgery and trabeculectomy. GDDs are even preferred nowadays as a primary procedure in selected cases where other surgeries are contraindicated or have very few chances to succeed. Furthermore, it has been found that 20% of pediatric glaucoma patients often require 2 or more surgical procedures for adequate IOP control, and GDDs are frequently used in the second or third surgical attempt.1 Glau

Dr. Rinal Pandit · Dr. Abhay Raghukant Vasavada