acute glaucoma

24
Z A L D I FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA MEDAN 2013 ACUTE GLAUCOMA 06/05/2013 07:18 1 Z A L D I ACUTE GLAUCOMA

Upload: hapiz-arlanda-sani

Post on 18-Jul-2016

17 views

Category:

Documents


0 download

DESCRIPTION

SLIDE KULIAH

TRANSCRIPT

Page 1: Acute Glaucoma

Z A L D I

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA

MEDAN

2013

ACUTE GLAUCOMA

06/05/2013 07:18

1

Z A L D I ACUTE GLAUCOMA

Page 2: Acute Glaucoma

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA2

Dengan menyebut nama Allah

Yang Maha Pengasih Maha Penyayang.

Page 3: Acute Glaucoma

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA3

Page 4: Acute Glaucoma

I. TUJUAN INSTRUKSIONAL UMUM

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

4

Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa glaukoma

akut dengan melakukan anamnese dan

pemeriksaan sederhana yang akan dipelajari

selama masa perkuliahan dengan baik dan

benar .

Page 5: Acute Glaucoma

II. TUJUAN INSTRUKSIONAL KHUSUS

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

5

Setelah Proses Belajar Mengajar mahasiswa

mampu mengetahui tanda dan gejala , faktor

resiko, prinsip pengobatan, komplikasi, dan

mengkonsulkan secara garis besar dengan

baik dan benar kasus-kasus glaukoma akut

sesuai dengan kompetensinya

Page 6: Acute Glaucoma

DEFINITION

ACUTE GLAUCOMA

(“Acute angle closure”)

occurs when sufficient

iris bombé develops to

cause occlusion of the

anterior chamber angle

by the peripheral iris.

06/05/2013 07:18

6

Z A L D I ACUTE GLAUCOMA

Page 7: Acute Glaucoma

CLASSIFICATION

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

7

Page 8: Acute Glaucoma

AQUEOUS HUMOR OUTFLOW

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

8

Page 9: Acute Glaucoma

AQUOS HUMOR OUTFLOW

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

9

Page 10: Acute Glaucoma

ETIOLOGY

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

10

HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT

SPONTANEOUSLY PUPILLARY DILATION

( when the level of illumination is reduced )

DRUGS ( anticholinergic or sympathomimeticeg, atropine , antidepressants, nebulizedbronchodilators, nasal decongestants, or tocolytics).

Page 11: Acute Glaucoma

HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

11

Page 12: Acute Glaucoma

CLINICAL FINDINGS

SUDDEN ONSET OF VISUAL LOSS

PHOTOPHOBIA

HALOS

NAUSEA AND VOMITING

INCREASED INTRAOCULAR PRESSURE

STEAMY CORNEA

CILIARY INJECTION

SHALLOW ANTERIOR CHAMBER

MODERATELY DILATED PUPIL

06/05/2013 07:18

12

Z A L D I ACUTE GLAUCOMA

Page 13: Acute Glaucoma

DIFFERENTIAL DIAGNOSIS ( 1 )

1. ACUTE IRITIS

o more photophobia ,

o IOP not elevated

o pupil is constricted or

irregular in shape

o cornea not edematous.

o flare and cells in AC

o deep ciliary injection.

06/05/2013 07:18

13

Z A L D I ACUTE GLAUCOMA

Page 14: Acute Glaucoma

DIFFERENTIAL DIAGNOSIS ( 2 )

2. ACUTE CONJUNCTIVITIS

bilateral

cornea is clear.

no photophobia ,

no visual loss

no ciliary injection

discharge

pupillary responses

IOP normal

06/05/2013 07:18

14

Z A L D I ACUTE GLAUCOMA

Page 15: Acute Glaucoma

COMPLICATIONS

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

15

1. ANTERIOR SYNECHIAE ( the peripheral

iris may adhere to the trabecular

meshwork )

2. IRREVERSIBLE OCCLUSION AC

3. OPTIC NEUROPATHY

Page 16: Acute Glaucoma

OPTIC NEUROPATHY

06/05/2013 07:18

16

Z A L D I ACUTE GLAUCOMA

Page 17: Acute Glaucoma

TREATMENT ( MEDICAL )

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

17

Acute Glaucoma is an ophthalmic emergency!

REDUCING IOP :1. Intravenous and oral acetazolamide

2. Topical agents : beta-blockers and apraclonidine,

3. Hyperosmotic agents : mannitol 20% , glicerol 50 %

4. Pilocarpine 2% , 4% ( by which time reduction of iris

ischemia and lowering of intraocular pressure allow

the sphincter pupillae to respond to the drug.

TOPICAL STEROIDS to reduce secondary intraocular

inflammation ( controversial )

Page 18: Acute Glaucoma

TREATMENT ( SURGERY )

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

18

1. LASER PERIPHERAL IRIDOTOMY ( YAG Laser)

( to form a permanent connection between

the anterior and posterior chambers, thus

preventing recurrence of iris bombé )

2. TRABECULECTOMY & PERIPHERAL IRIDECTOMY

3. PROPHYLACTIC LASER IRIDOTOMY (fellow eye)

Page 19: Acute Glaucoma

PERIPHERAL IRIDECTOMY

06/05/2013 07:18

19

Z A L D I ACUTE GLAUCOMA

Page 20: Acute Glaucoma

TRABECULECTOMY

06/05/2013 07:18

20

Z A L D I ACUTE GLAUCOMA

Page 21: Acute Glaucoma

21

GLAUCOMA Optic Neuropathy VF loss

Neuroprotection

OBFIOP

PP BPSclerotic vascular wall vasospasmIOP

Mechanical damage

Neutrophin withdrawal

Stop axoplasmic

flow

RetinaISCHEMIA

ONH

Vascular dysregulation

RGC death

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

Page 22: Acute Glaucoma

REFERENCES

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

22

American Academy of Ophthalmology, Glaucoma,

Section 10, 2011-2012

American Academy of Ophthalmology, External

Disease and Cornea, Section 8, 2011-2012

Khurana AK, Comprehensive Ophthalmology, Fourth

Edition , New Delhi, New Age Internasional (p) Limited

Publisher, 2007.

Vaughan & Asbury's : General Ophthalmology

17th Edition , Mc Graw- Hill’s Companies , May 2007

Page 23: Acute Glaucoma

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA23

Segala puji bagi Allah, Tuhan semesta alam.

Page 24: Acute Glaucoma

THANKS YOU

06/05/2013 07:18Z A L D I ACUTE GLAUCOMA

24