chronic glaucoma treatment / seeos / tirane / 18-06-2010 / prof.dr.ilhami goranci , dr.ardiana...

7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.

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SOME DILEMAS IN CHRONIC

OPEN ANGEL GLAUCOMATREATMENT

Ilhami Goranci, Ardiana Goranci Baruti,Dafina Goranci Rexhebeqaj,

Halil Ajvazi, Dardan Goranci


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Glaucoma

Is a disease of progressive opticneuropathy with loss of retinal neuronsand the nerve fiber layer,resulting inblindness if left untreated.

Is a third leading cause of blindess inthe world.

Affects about 13,5 milion people allover the world,and around 6,7 milons ofthem are blind.


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Most common type of glaucoma is

chronic primary open angleglaucoma(POAG).


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Risks factors in POAG Age

-prevalence ranges around 15%in those older than 70 years

Family history

-when one parent suffer from glaucoma,risk increases up to to 2..2times

Chronic systemic diseasses

-diabetes-cardiovascular disease

Eye disorders

-corneal thickness

-pseudoexpholiations

-myopia,hypermetropia


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Diagnosification

Gold standards tests

-Tonometry

-Perymetry

-Optic disc examination-Gonioskopy

-Daily tonometric curve

The newer tests

-Nerve fibere layer analyzers(GDX,OCT,HRT)-Ocular blod flow measurment,and

-Ultrabiomicroskopy(UBM)


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Therapeutic modalities for POAG

Medicationfirst line of treatment Laser (SLT,ALT)

Surgery treatment


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Medical therapy

POSITIVE IMPACT

drops carries the least risk

NEGATIVE IMPACT

Side effects of effective drops Allergy to presrvatives

Several medication

Life long regiment(especialy to young patients 40-

60 years) Patient quality of life

Expense of treatment


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Treatment of CHPOAG has thisperformance

Aplications of B-blockers

-IOP controlled> 21mm Hg - failure

+Vazoprotektor+Neuroprotektor alternate monotherapy

a-agonist,PG,CAI

- failure

Surgery

Continue treatment,

Reviw every 3-6 months


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Surgical therapy

POSITIVE IMPACT

More cost effective than life time medication.

Patient do not have daily phsycological burden of

treating the disease.

NEGATIVE IMPACT

Invazive method.

In and post operative complications. After surgery IOP is not always normalised.

Continuing glaucoma damages.


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THERAPY DESSISION FORGLAUCOMA

Treating glaucoma is difficult decision of both theopthalmologist and patients,especialy in somespecific situations.


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DIFFICULT SITUATTIONCOMMON FOR OUR CASES

Patient unable to afford treatment

(fullcost of medical care is on paient)

Absence of free preservative drops in our country. Problem with self administration of drops

(absence of social service)

Our experience shows that 50% of patients do notuse their drops as prescribed


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The goal of glaucoma treatment is to preserve thevisual field of patient and prevent the loss of visualfunction that is associated with the disease.

Our target in presented cases was to get the pressurewell kontrolled by medication or surgery.


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Materials and methods

We undertook our study to review ourPrivate Practice in Prishtina andRegional hospital in Prizren experiencein CHPOAG treatment success.

15.362 pacient were enroled in ourstudy between 2006-2009.

486 of them were with glaucoma146 with POAG.


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Number of treated patients

0

50

100

150

200

250

300350

400

450

500

486 (3.2%)

146(29%)

Graf.1 Total patient no.

with

glaucoma

with

CHPOAG


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Number of patient with CHPOAG types

0

10

20

30

40

50

60

70

80

90 82(56%)

61(42%)

3(2%)

With glaucoma

simplex

Glaucoma

capsulare

Glaucoma

Pigmentos.

Graf.2.

Total no 146

(100%)


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From 146 patient with CHPOA compensation of IOPafter medical therapy was

-74(from 82 cases with Glaucoma simplex)

-53(from 61cases with glaucoma capsulare),

and

-2(from 3 cases with Glaucoma pigmentosum)


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Compensation of IOP after medical therapy

0

10

20

30

40

50

60

70

80

-Glaucoma

simplex 82

cases

-Glaucoma

capsulare

-Glaucoma

pigmentosum

74(90.2%)

53(88.5%)

8(9.8%) 8(11.5%)

2(67.0%) 1(33.0%)

Graf.3 Comp. Not comp. Comp. Not comp. Comp. Not comp.


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Percentage of medical and surgicaltreatment

From 146 patients with CHPOAG-102 were medical treated

-32 were surgical treated


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Percentage of medical and surgicaltreatment

0

20

40

60

80

100

120

140

Graf.nr 4.

total 146(100) Medical treated Surgical treated

.

102(76.8%)

32(23.2%)


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We did selected four cases for ourpresentation.


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First case I.D., 61 y.

OD OS

Dg. Glaucoma.caps.Invet.

decompens.

Glaucoma caps. inic.

VO,TO,dh FO 0.10/60 42 mmHg,E 0.9 D.IV.

1.0, 22 mmHgE 0.2. D.I

Asimetric

glaucoma

Gonioskopy Open angel,light pigment. Open angel,light pigment.

VF Its not determinated With inicial damages

Right eye is

operated

Dg.Gl.caps.

subcomp

After operation

Gla.cap.invet.subcompe.

-.Xalatan -Xalatan


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Second case V.C., 66 vj

OD OS

Dg. Glaucoma caps.inic..compens..

Gl.capsul.init.subcom.

VO.TO.

FO

1.0, 19 mmHg,E 0.4, D.I-II.

1.0, 24 mmHg,E 0.4, D.II.

Asimetrik glaucoma

Gonioskopy Open angel,light

pigment.

Open angel,light

pigmented.

VF Initial damages Initial damages

After medicaltherpyIOPwas normal.TO

Patient is on foolow up

-.Trusopt

-.Xalatan

18 mmHg

-.Trusopt

-.Xalatan

16 mmHg


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Third case SH.M.,61vjet

OD OS

Dg Hyperopia et gl.caps.init. subcomp.

Hypertensio bulbi

VO,TO,FO 0.9cc, 23 mmHgE O.4 D.I-II

1.0sc ,22 mmHg,E.0..2 D.I

Asimetric gl.Gonioskopy

FV

Open angel

Initialdamages

Open angel.

No damages

After medical

therapy IOP isnormalised

-Timolol 0.5% -Timolol 0.5%

TO

Patient is followed

upforfive years

18 mmHg 16 mmHg


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Fourth case M.K., 70 y

OD OS

Dg Gl.simlex.inic.subcomp.

St.posthaemor.cent.retine.

VO,TO,FO 0.9sc, 25 mmHgE.O.4, D.II.

0.3sc, 17mmHg,E.O.2 ,D.I.

Gonioskopy Open angel Open angel

V F

Asimetris glaucoma

After treatment IOP

was normalised

Initial damages

Timolol 0.5%

Trusopt

With no damages

TO 15 mmHg 17 mmHg

Patient is followed up

for 4 years


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Discusion

In 114 of our cases with POAG treated with medicaltherapy we did get the pressure well controlled.

We did perform operation in 32 of patient.

In 20 cases despite our best efforts IOP remainsdecompensated.


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Cairns(1972) reported 48% controlled with adrainage bleb.

Cvetkovic reports 5% operated pacients from all his

cases.

Retrospective study(P.Ehnroth) demonstarted that50% of eyes initially treated with medicationsrequired surgical intervention.


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Conclusion

Therapy for glauocoma can be effective only ifpatient fill their prescription and take theirmedication as directed

With good patient compliance with drops andregular follow up ,their glaucoma is kept stable formany years,althought in some patients glaucomamay progress, despite best efforts.


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THANK YOU FORYOUR ATTENTION

chronic glaucoma treatment / seeos / tirane / 18-06-2010 / prof.dr.ilhami goranci , dr.ardiana...

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