Final Session: Glaucoma

Daniel Mojon, MD, FEBO, EMHSA

sli.do

#saoo2020

Plenum 1

Plenum 2

Plenum 3

Learning Goals:

- Origin of the word glaucos

- Connection between glaucos and cataracts

- Couching: how is done

- Gonioscopic findings

- Decision findings to lower IOP

- Medical treatment options / ATP or SLT

AAO 2014

Glaucos

- Pre-Hippocratic Era

Green eye, sea (not unhealthy!)

- Hippocrates (460-370 BC)

Pupils which have become γλαυκοu ́μεναι [glaukoumenai] or

ἀργυροειδέες [argyroeidees, silvery] or κυἀνεαι [kyaneai, cyan]

are useless (Aphorisms III.31.6)

Couching first mentioned?

A) Small statue from the 5th dynasty (2457-2467 BC)

Egyptian Museum in Cairo

B) Code of Hammurabi (1792-1750 BC)

C) Indian surgeon in “Sushruta Samhita, Uttar Tantra”

Indian medical treatise (800 BC)

2 years old child

2 years old child

2 years old childGonioscopic view of trabeculectomy

What do you expect?

A) No filtering bleb

B) Nice, but too anterior filtering bleb

C) Nice, but too posterior filtering bleb

Gonioscopic finding 3 weeks after deep sclerectomy

A) Miotics

B) Miotics and heat

C) YAG-laser synechiolysis

D) Laser iridotomy

E) Revision in the OR

IOP 24 mm Hg: LEAST important for decision to lower IOP

A) Visual fields

B) Ganglion cell layer

C) Nerve fiber analysis

D) Optic nerve parameters

E) Central Corneal Thickness (CCT)

First line treatement in a healthy 65 years old POAG patient

A) Prostaglandins

B) Beta-blocker

C) Carbo anhydrase inhibitors

D) Alpha-adrenergic agonists

E) Parasympathomimetics

ALT or SLT?

A) ALT

B) SLT

C) Both should not be used anymore

Take Home Messages

- Glaucos: Hippocrates no couching!

- Couching: ESCRS video

- Trabeculectomy: inner opening not too anteriorly

- Recent PAS after DS: miotics and heat!

- Decision making if IOP elevated

- First line treatment for elevated IOP

- Role of ALT / SLT