Chronic Glaucoma

Risk factors
• High IOP (> 21mmHg)
• Thinner Central Corneal thickness
• Aging
• Family history (Among first degree relatives)
Chronic glaucoma: what is happening ??

Either: Or poor blood

the drain blocks supply here
here Damages the optic
nerve..looks ‘caved in’,
called ‘cupped’
Characteristic pattern of loss of visual field
Rim of optic nerve becomes
thinner as disc caves in and
becomes more cupped
 When to refer ??
• IOP > 21mmHg or difference in IOP in both eye
> 3mmHg
• Cup disk ratio > 0.5
• Other optic changes:
• Disc hemorrhage
• Undercutting of the neuroretinal rim
• Thinning of the neuroretinal rim
• When in doubt !!
• History ??
• Examination??
• Ophthalmoscopic Findings:
a. Pale optic disk
b. Central cup expands (Cup:Disc > 0.4)
c. Neuroretinal rim thinner
d. Cupping
 Treatment
• Medical treatment
• Laser trabeculoplasty
• Surgical treatment – trabeculectomy
Diabetic Maculopathy
 Stages of Diabetic retinopathy
• Background retinopathy
• Maculopathy
• Pre-proliferative
• Proliferative
 Diabetic Maculopathy
• Macula – central area of retina
 Types
• Focal
• Diffuse
• Ischemic
• Mixed
Characteristics of Clinically Significant Macular Edema ( CSME )

• The leading cause of visual loss amongst diabetics. Diagnosed by

stereoscopic assessment of retinal thickening, usually by slit lamp
biomicroscopy.

• Defined as the presence of one or more of the following, ( Modified Airlie

-House Criteria )
 
– Retinal oedema within 500 microns of the centre fovea.

– Hard exudates within 500 microns of fovea if associated with adjacent retinal thickening

– Retinal oedema that is one disc diameter or larger, any part of which is within one disc
diameter of the centre of the fovea.

– Laser grid photocoagulation reduces the risk of visual loss by 50% at 2 years
 Treatment
• Aim: resolution of the retinal edema before
fovea is involved

– Good Glycemic control

– Triamcinolone may reduce macular oedema more
effectively. Avastin may work if repeated injections
are given
– Laser
THANKS 