opthalmology

medication

eye drops

pills

Prostaglandin analogs

Latanoprost (Xalatan)

Bimatoprost (Lumigan)

Travoprost (Travatan)

Beta blockers

side effects

Adrenergic agents

Miotics

side effects

Pilocarpine

Carbonic anhydrase inhibitors

laser surgery

Trabeculoplasty

for open angle glaucoma

most common

takes 10-15 minutes

results in a few weeks

focus on the drain so that aqueous fluid can pass easily out of the drain

types

Argon Laser Trabeculoplasty (ALT)

Selective Laser Trabeculoplasty (SLT)

Laser Peripheral Iridotomy (LPI)

Cycloablation

open-angle glaucoma

reduce aqueous humor by destroying part of ciliary body, which produces the fluid

for elevated IOP after other treatments failed

Transscleral cyclophotocoagulation

go through the outer sclera

Endoscopic Cyclophotocoagulation (ECP)

instrument is placed inside the eye to apply energy directly to the ciliary body tissue

surgery

Trabeculectomy

when laser/pills don't work

open & closed angle

passage in the sclera

white of eye

flap allows fluid to escape

Drainage implant

a silicone tube extends into the anterior chamber

less efficient than trabeculoctomy

preferred in some cases

scar tissue, etc.

Nonpenetrating

newer

doesn't enter anterior chamber

requires greater surgical acumen

not as effective at trabeculoctomy

alternatives

ExPress mini glaucoma shunt

stainless steel device

in anterior chamber, under the scleral flap

Trabectome

in anterior chamber through the cornea

a probe

uses heat to warm up the trabecular meshwork

reduce resistance to outflow of aqueous humor

Canaloplasty

improve aqueous circulation through the trabecular outflow

ocular version of angioplasty

extremely fine catheter to clear the drainage canal

IOP

Intraocular Pressure

ocular hypertension

Optic nerve cannot tolerate high pressure

loss of retinal ganglion cells

above 2.8 kPa

most people, with treatment, will not lose their sight

Ciliary processes

Aqueous humor

drained by trabecular meshwork

vision loss irreversible

visual field reduced

All types of optic neuropathy

Surgery

to replace cloudy lens

Phacoemulsification

Capsulorhexis

circular hole in the capsule where lens sits

Phacoemulsification

use ultrasound to to emulsify or turn the lens into liquid, and then suck it away

a plastic lens is inserted instead

Extracapsular Cataract Extraction (ECCE)

remove the lens manually, leave capsule intact

when emulsification is problematic

Manual Small Incision Cataract Surgery

remove the lens through a scleral tunnel wound

incision very large

popular in developing countries w/out access to phacoemulsification

Intracapsular Cataract Extraction (ICCE)

complications

complications

retinal detachment

endophthalmitis

AGE bodies stick to lens?

loss of photoreceptors

Oxidative stress

mitochondrial dysfunction may play a role

dry

common

atrophy and scarring

wet

abnormal vascularization

possible to slow down the "wet" form