Glaucoma - Symptoms and Treatment
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| glaucoma |
Article Content:
- Definition
- Open angle glaucoma
- Closed-angle glaucoma
- Chronic Glaucoma
- Congenital glaucoma
- Neovascular Glaucoma
- Pigmented Glaucoma
- Risk factors
- Symptoms
- Treatment
See also: glaucoma
Glaucoma is a chronic disease caused by the progressive destruction of the fibers of the optic nerve under the influence of various factors, the most common of which is the abnormal elevation of intraocular pressure (IOP). It affects about 1% of the population over the age of 40 and is the second leading cause of blindness in developed countries after age-related macular degeneration. Glaucoma, the leading cause of total blindness in developed countries, affects over one million people in France, half of whom are unaware of it.
Definition
Open angle glaucoma
Closed-angle glaucoma
Chronic Glaucoma
Congenital glaucoma
Neovascular Glaucoma
Pigmented Glaucoma
Risk factors
Symptoms
Treatment
See also: Glaucome
Ocular hypertension is not synonymous with glaucoma: some hypertonias do not cause glaucoma and there is a form of glaucoma in which IOP is within normal limits.
Definition
Glaucoma is a chronic condition caused by the progressive destruction of the fibers of the optic nerve under the influence of various factors, the most frequent being an abnormal elevation of intraocular pressure (IOP). The increase in intraocular pressure is caused by obstruction of the intraocular fluid evacuation filter. It can lead to an irreparable decrease in the field of vision followed by a total loss of vision if no treatment is envisaged.
Open-angle glaucoma
Glaucoma is a pathology of the eye due to an increase in the pressure in the eye which will lead to damage to the optic nerve and therefore a narrowing of the visual field that can evolve to blindness.
This elevation is caused by a decrease in the flow of the liquid contained in the eye called aqueous humor. Open-angle glaucoma is chronic glaucoma and is the most common glaucoma. It is opposed to closed-angle glaucoma which is abrupt and causes significant blindness.
It evolves gradually and can be suspected before a complaint of decreased visual field and the discovery of a pale papilla. Several examinations will be performed by an ophthalmologist as a fundus, a measurement of the intraocular pressure and a gonioscopy.
It is possible to treat this glaucoma if it is detected early enough, but alas the first symptoms appear only in advanced stages.
Closed-angle glaucoma
Glaucoma is an ocular disorder characterized by progressive degradation of the optic nerve due to high pressure inside the eye because the aqueous mood evacuates badly. It only touches one eye. There are two types of glaucoma: open angle and closed angle. The latter is rarer, it manifests itself by a vivid and continuous eye pain, a dilated pupil, a diminution of the visual field and nausea. This is a medical emergency that requires surgery or laser intervention. Before the procedure, the doctor will inject (intravenously) acetazolamide (Diamox®) to reduce the pressure inside the eye. Without treatment, the evolution is rapid and leads to loss of sight.
Chronic glaucoma
Chronic glaucoma is another name for open angle glaucoma. The optic nerve, transmitting the images of the eye to the brain, is gradually destroyed because of an excess of pressure in the eye. Evolution usually affects both eyes and progresses towards total loss of vision or blindness. We speak of chronic glaucoma when the evolution is over several years: it is generally an open angle glaucoma, in contrast to another type of glaucoma that appears suddenly and whose risk of blindness is very great: the GAAF Or closed angle glaucoma. The first declines in vision are only seen at advanced stages of the disease. Thus, in the presence of a reduction in vision, a consultation with an ophthalmologist for a fundus and according to the suspicion, a possible measurement of intraocular pressure allows early treatment.
Congenital glaucoma
A congenital glaucoma is a rare form of glaucoma that is characterized by significant intraocular pressure from birth or during the first few weeks of life. The child tears, for the aqueous humor in the eyes, evacuates badly. Impairment is in most cases bilateral and boys are more affected than girls. It often results from a genetic anomaly, although some children have no abnormalities. Eye drops (drops) may be sufficient. Eye surgery is necessary to treat the most severe cases.
Neovascular glaucoma
Several forms of glaucoma are distinguished, including neovascular glaucoma. This is secondary glaucoma, the occurrence of which is often associated with another pathology of the retina, such as vascular occlusion,
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The Basics of Glaucoma Treatment
1- General considerations:
Glaucoma is a chronic disease whose treatment aims to stabilize the progression of the loss in FNR, in order to preserve the visual function. Indeed, glaucoma is a "neurological" disease in the sense that it affects nerve cells that once destroyed can not be replaced. The treatment is rarely punctual, it is rather chronic and once started continues throughout life.
Neuroprotection is a very promising field of research and despite this in 2008, the treatment of glaucoma is based on the control of its risk factors ... Among the risk factors for glaucoma that can be acted upon, IOP lowering is the only one that has proven to be effective at present. This is why, regardless of the stage of the disease, the first-line therapy, and throughout the follow-up, will aim to lower IOP to such an extent that the FNR loss Closer to the physiological loss; This level of pressure drop represents the goal to be achieved, this is the "target IOP". In order to achieve this, several options are possible, generally, hypo tonicizing eye drops are proposed in the first intention, but laser treatments can prove effective or even surgery can be indicated.
2- Medical treatment:
It is generally based on the instillation of drops in the eyes but may occasionally involve taking a general drug, ACETAZOLAMIDE or Diamox®.
Also by the general way are sometimes advocated vasculoprotective or vasodilating drugs or even vitamins and food supplements.
Ocular hypnotizing eye drops are numerous, they act through a decrease in the production of aqueous humor or by an increase in its evacuation.
Eye drops are real drugs, and at the ophthalmological level, their galenic form allows a direct attack on the therapeutic target without passing by the general circulation.
Among the therapeutic families used in the management of glaucoma:
- parasympathomimetics (pilocarpine) and prostaglandin analogs (latanoprost, travoprost, bimatoprost) make it possible to increase the evacuation of aqueous humor
- beta-blockers (timolol, carteolol, betaxolol, levobunolol, etc.), carbonic anhydrase inhibitors (dorzolamide, brinzolamide) decrease the production of aqueous humor
- sympathomimetics (brimonidine, apraclonidine) limit the production of aqueous humor and favor to some extent its flow.
- combinations of active principles, generally act on the production and evaluation of aqueous humor, combining complementary actions.
3- Alternatives, laser supplements:
Several types of laser can be used in the management of glaucoma.
A- This may be a treatment intended to "rectify" or modify an anatomical configuration predisposing to the occurrence of acute or chronic closure glaucoma. These treatments are laser iridotomy and rhinoplasty.
Laser iridotomy (argon and/or Yag) consists of making a hole in the peripheral iris to constitute a short circuit to the iris that would tend to obstruct the passage of aqueous humor towards the trabeculae.
Argon laser rhinoplasty consists of modeling the iris base in such a way as to distance it from the corneal ride angle in certain indications such as, for example, in the plate rises where the basal plane makes an angle which tends to obstruct the trabecular.
B- It may be a laser treatment aimed at "widening" the meshes of the trabecular, it is then a trabeculoplasty.
The laser treatments mentioned above are in fact carried out during the consultation, on a laser lamp dedicated to the laser; A preliminary preparation of a few minutes may be necessary with the aid of colleges to tighten the pupil. The anesthesia is topical on the eye to be treated in order to be able to place the focusing lens which will make it possible to carry out the treatment. Laser treatment is usually painless even if described as unpleasant. An anti-inflammatory and hypnotizing post-laser treatment is added to the usual treatment for a few days.
C- The laser diode cyclo-weakening, as its name suggests, consists of applying the laser diode to the ciliary body via the sclera facing or endovascularly. The ciliary body producing the aqueous humor, its partial destruction will reduce the production of aqueous humor and thereby decrease the IOP.
This type of treatment can be painful, it is usually done in the operating room under local anesthesia.
This type of treatment can have definitive side effects, which limits its indications. It is proposed that refractory glaucoma is resistant to other types of treatment.
4- Surgical treatment:
Glaucoma surgery will not, as would be expected, treat this pathology, as it is generally cured of its crisis after an appendectomy.
The aim of the surgery is to lower the IOP without direct action on the pathology itself, it would have the action of a "super college" that one would not have to install ... It n Is not synonymous with permanent elimination of eye drops, or indications of laser treatments for the sequel. It is an additional means in the arsenal to reduce IOP.
A fundamental precision is to be understood in the matter, the surgery does not have the ambition to restore a vision, it has the ultimate objective to preserve the visual field remaining.
As a general rule, unavoidable indications of surgery are unbalanced IOP despite maximum medical treatment with worsening visual field defects, poor tolerance to medical treatment, insufficient response to laser treatments.
Glaucoma surgery can be performed, and this is most often the case under local anesthesia; So an anesthesia consultation must be scheduled before the surgery in order to assess the general condition of the patient and eliminate any contraindications to surgery. This surgery can be considered in outpatient or in traditional hospitalization. It is, of course, carried out in a sterile medium in the operating room.
Postoperative follow-up is crucial and several visits will be required. Adjuvant treatments for surgery may be indicated with occasional injections of anti-healing products in the postoperative suites. Of course, once the postoperative period has passed, patient follow-up remains essential even if the IOP is balanced because once again the surgery does not treat the disease ...
The goal of glaucoma surgeries is to promote aqueous humor filtration, which is why they are called "filtering surgeries". Several techniques can be envisaged, the ultimate choice belonging to the surgeon concerned, according to the clinical case presented by the patient, and his personal experience.
4-1 Trabeculectomy:
The goal of this surgical technique, carried out for more than 40 years, is to create a "hole" in the trabecular to promote the evacuation of fluids from the eye under cover of conjunctival sclerosis. It is, therefore, a perforating filter surgery.
Trabeculectomy post-operative filtration bubble
Trabeculectomy visualized in ultrasound UBM
4-2 Non-perforating deep splenectomy:
It is intended in general for broad AICs, and consists of "refining and weakening" the filtration site that is the trabeculae without perforating it, it allows to increase the trabecular permeability without creating a continuity solution.
Deep non-perforating splenectomy observed in ultrasound in UBM
Other filtering surgery techniques may be practiced such as Visco canal ostomy; The installation of shunts or valves are in the order proposed to subjects at high risk of failure or refractory glaucoma.
The above-described filtering surgeries may be combined with cataract surgery at the same time. It may be necessary to perform a new procedure in time (it is not because we have been operated that we can no longer be a candidate for a new Glaucoma surgery).
4-3 Surgical iridectomy:
In some cases, an anatomical predisposition or closure of the corneal ride angle causes laser iridotomy to be considered, which can not be performed for various reasons, then a surgical iridectomy is envisaged which involves making a "hole" in The peripheral iris there again to shut the obstacle and allow the aqueous humor to pass on either side of the iris.
4-4 Complications:
Any surgery involves risks, and without ignoring them, it also seems important not to summarize the surgical procedure to its potential complications. If a surgery is proposed to you, it is above all to improve the prognosis of a pathology difficult to treat medically. Nevertheless, being aware of the risks is important and is part of the questions to ask his surgeon during preoperative consultations.
These complications may be minor, hemorrhagic, inflammatory or pressure-related; They can be more annoying and possibly affect vision in rarer cases. The occurrence or aggravation of a cataract after this type of surgery is also possible. Monitoring of the surgical site is essential in the short, medium and long term. An infectious complication, even very late, is always feared: any unexplained eye pain with possibly decreased visual acuity must lead to an ophthalmological consultation in urgency.
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