There are three basic possibilities for treating glaucoma:
- By medication (eye drops, tablets )
- By laser surgery
- By conventional surgery
glaucoma can be treated but is not curable. In other words, it means that we are able to control the disease to avoid a decrease in visual acuity but that we can not intervene on the damage already present because they are irreversible.
This disease is treated with medications (eye drops and tablets), laser surgery, traditional eye surgery or a combination of these methods. The main goal in the treatment of glaucoma is to lower the intraocular pressure. One always tries first with a treatment based on eye drops.
Most often, it is only when this treatment is not effective enough, either that the pressure remains too high or that the damage to the optic nerve or the visual field is progressing, that other treatments are taken into consideration. Although the chances of success are the best for decreasing intraocular pressure, there are still other therapeutic objectives such as improving blood perfusion or protecting nerve cells in the optic nerve before damage occurs ( Neuroprotection ).
Most often, it is only when this treatment is not effective enough, either that the pressure remains too high or that the damage to the optic nerve or the visual field is progressing, that other treatments are taken into consideration. Although the chances of success are the best for decreasing intraocular pressure, there are still other therapeutic objectives such as improving blood perfusion or protecting nerve cells in the optic nerve before damage occurs ( Neuroprotection ).
Patient collaboration:
Unfortunately, patient collaboration is often not optimal in the case of glaucoma. This is certainly related to the fact that glaucoma itself does not cause symptoms and that eye drops are sometimes unpleasant.
Patients with glaucoma will have to cope with some unpleasant treatment-related effects and believe in the currency that a drug that has no side effect can not be effective.
If glaucoma is diagnosed, treatment for life should be followed. However, by knowing the dangers to the eye in case of glaucoma, it is easier to follow the doctor's recommendations. Always think of this: "You do not put your drops to please your doctor but to avoid becoming blind! If you do not know how to put your drops, talk to your doctor but do not do anything on your own!
MEDICATION
Eye drops
All eye drops can cause burning sensations in the eyes. This is not necessarily linked to the active substance itself but to the antibacterial substances added to the liquid. Some drugs have only a short duration of action and must, therefore, be used according to a specific schedule during the day. It is important to comply strictly with the prescriptions because otherwise the pressure may not be sufficiently lowered.
The active substances contained in the eye drops can reach into the blood. This is why it is important that you tell your ophthalmologist what other treatments you are taking and what other diseases you are suffering from. The practitioner can then decide which ophthalmological treatments he may prescribe.
The active substances contained in the eye drops should penetrate as far as possible into the eye and pass as little as possible into the bloodstream. The greater part of the fraction of the ocular drops, which passes into the blood system, reaches it through the nasal mucous membrane. You can do something to prevent this. Close your eyes for 1 to 2 minutes after putting the drops and lightly compress the corner of the eye on the nasal side. The lacrimal canal closes when compressed and the drops can no longer pass through the nose.
Now we will discuss the various drugs, used in the form of drops, in the treatment of glaucoma. The list below is not exhaustive, it is regularly updated.
Drug groups
- Effect
- Side effects
- Parasympathomimetics
- Pilocarpine
- Aceclidine
- Carbachol
Opening of the trabecular and improvement of the flow of aqueous humor
Contraction of the pupil, Accommodation (adaptation of the eye to near vision), Allergy, asthma, Sweating, Digestive disorders
Sympathomimetics
Adrenaline
Dipivefrine
Apraclonidine
Brimonidine
Opening of the trabecular and improvement of the flow of aqueous humor
Neuroprotector?
Redness of eyes, palpitations, elevated blood pressure, headache, tremors
Sympatholytic
Timolol
Betaxolol
Levobunolol
Cardiology
Metipranolol
Decreased production of aqueous humor resulting in lower intraocular pressure
Respiratory disorders in asthmatics, decreased heart rate, decreased blood pressure and other
Carbonic anhydrase inhibitors
Dorzolamide
Brinzolamide
Decreased production of aqueous humor resulting in lower intraocular pressure
Eye Reduction, Burns, Increased Iris Pigmentation, Iris Browning
As for side effects, we would like to mention here, which many patients do not present at all. Read the information leaflet that accompanies your medication or asks your doctor.
In some cases, eye drops alone are insufficient to reduce the intraocular pressure sufficiently. In this case, it is necessary to take a tablet treatment in addition to the eye drops. As the active substance is no longer directly applied to the eyes but reaches it through the blood, side effects may also be more numerous (see "effects and side effects").
Patients with normal pressure glaucoma or glaucoma in which the pressure is sufficiently lowered but continues to progress can benefit from treatment that improves blood perfusion. In this group of drugs are the antagonists of calcium and magnesium. These drugs, at prescribed doses, have a minor vasodilatory effect and have a regulatory effect on the vessels, so that the hyperreactive vessels show less paradoxical contractions. In some patients, it is also advantageous to raise the strain of blood pressure a little by increasing the intake of salt in the food or by prescribing tablets (see appendices ).
If the patient does not support drug therapy or the desired effect is not achieved, an attempt should be made to lower the intraocular pressure in another way.
Laser surgery has become a very important tool in ophthalmology. The most common method of laser surgery in open angle glaucoma is what is called trabeculoplasty. This procedure lasts 10 to 20 minutes, it is painless and does not require hospitalization. The patient can go home after the surgery and go to these occupations.
Laser surgery
The laser beam is directed at half the circumference of the camera angle and will serve to burn slightly the trabecular tissue in about fifty points. The burns will subsequently, by healing, stretch the adjacent parts which will facilitate the flow of the aqueous humor.
A reduction in intraocular pressure can thus be obtained in more than 80% of cases. However, it may take several weeks before the desired effect is achieved. During this time the patient should continue his treatment of eye drops. Often the patient can not completely stop the treatment with drops, despite the laser procedure. This is not always the case and your ophthalmologist will advise you what to do in your case. Unfortunately, the results obtained by this method are limited in time and often serve only to repel a conventional ocular operation.
CONVENTIONAL SURGERY
As mentioned above, in the case of therapeutic drug failure and laser surgery, a conventional operation may become necessary.
Konventionelle-Chirurgie
The most commonly used method is called trabeculectomy.
It is done under local anesthesia of the eye and the patient remains under observation at the hospital the following night. Sometimes, depending on the case, the patient can go home the same day. The patient should know that it may take a long time to recover the same visual acuity that he had before the operation. In this method, a flap is made in the sclera, which allows the aqueous humor to flow freely into the conjunctiva, which will have the effect of bringing down the intraocular pressure. Most patients can thus stop treatment that lowered intraocular pressure.
Although trabeculectomy is a relatively effective and safe method of treatment, surgery may also be associated with undesirable side effects such as inflammation, infection, or corneal problems with the operated eye. One-third of patients develop cataract within 5 years of surgery. Moreover, the good result of the operation can be wiped out when the new opening thus made closes by healing.
************************************************** *********
Glaucoma
glaucoma is a disease of the eye due to increased pressure inside the eyeball. The normal values of the pressure in the eye are between 15 and 21 mm Hg. Above these figures, the optic nerve can be reached with progressive degradation of vision. There are no clear warning signs.
This increase in pressure results from an accumulation of a liquid (the aqueous humor) in the eye.
There are two types of glaucoma, one of which must be treated urgently because of the rapid rise in intraocular pressure. Fortunately, this is the rarest.
One million people in France are affected by this disease, which affects mainly adults after the age of 40 years. However, the child and the young adult can be affected.
Some glaucoma has a family origin, which justifies screening in children with one of the parents with glaucoma.
Importantly, glaucoma is not accompanied by any signs, since vision can be preserved for a very long time. This means that only a routine examination by an ophthalmologist can detect an incipient form of glaucoma;
WHAT IS HAPPENING
The aqueous humor is made in the eye. It is eliminated by a small canal to a tissue called the trabecular which absorbs its resorption. When the resorption decreases, the liquid accumulates, the pressure rises. It is open-angle glaucoma.
If nothing is done, there may be the danger of the optic nerve (lesion) and vision (decreased visual acuity and possible loss of vision).
If one consults at the right time, everything goes well because the ophthalmologist quietly has time to act.
This is, fortunately, the tendency for the majority of those who are increasingly in the habit of consulting annually, either for a routine visit or for the classic problem of a vision to be settled.
Glaucoma The eye is composed of two compartments that contain two different liquids: the aqueous humor in the front chamber and the glazed humor in the back chamber. Glaucoma, which is a common cause of blindness, is a disease that affects the flow of aqueous humor, causing an increase in intraocular pressure which eventually causes damage to the optic nerve responsible for transmission of images to the brain.
TWO TYPES OF GLAUCOMA DISTINGUISHED
Primary glaucoma (without special reasons).
Congenital glaucoma
And secondary glaucoma (occurring as a result of certain ailments).
Primary glaucoma:
This is the most common. It is said to be primitive because it occurs during life, unlike congenital glaucoma that exists at birth and secondary glaucoma that occurs as a result of other diseases or problems of the eye. There are two types of primary glaucoma: open angle and closed angle glaucoma.
So called because of the large width of the angle that anatomically exists between the iris and the cornea. The pressure due to this width is not too high at the beginning. This explains that this glaucoma is well tolerated at the beginning. It causes a gradual increase in eye tension.
It is frequent glaucoma (800,000 people affected in France). It often has a family origin (genetic). It usually appears after quarantine and it touches both eyes. It is silent at first but fortunately diagnosed if ophthalmologist surveillance is regular.
In some cases, the disease progresses while the pressure in the eye remains normal. This is why this disease is formidable because it causes no pain or loss of visual acuity.
In other rare cases, open-angle glaucoma occurs ... secondary to trauma or prolonged use of corticosteroids.
It is estimated that one in two people in France does not know that she has glaucoma. It is, therefore, the only examination by an ophthalmologist that makes it possible to detect it.
Last remark: some people carry "ocular hypertonia", that is to say, an increase in the intraocular pressure without there being compression of the optic nerve and therefore the risk of blindness. It is considered, however, that persons in this condition are in the "pre-glaucoma" stage.
Factors favoring: age over 40, ethnicity (blacks are more often affected than white), heredity (one or more cases of glaucoma in the family), myopia, diabetes And taking corticosteroids.
So called because of the narrowness of the angle cited above. The pressure rises abruptly by completely blocking the angle.
This glaucoma is less common. It usually involves only one eye. It can intervene earlier.
It is quickly discovered through its noisy symptoms: acute seizures of eye pain with the transient decrease in vision. Care must be taken urgently. His treatment is surgical or laser. Taken early, it poses no problem.
Certain chronic glaucomas (that is to say, evolving at low noise and by flares) are more pernicious because the eye pain is less clear, the visual acuity is conserved with the only appearance of colored halos.
The predisposing factors are: ethnicity (Asian women are particularly affected), female sex, age from 50 years, stress, hyperopia, cataracts, certain medications (anti- Diarrhea or antitussive syrups
Congenital glaucoma
It is particular glaucoma.
It is rare and appears from birth.
It is so called because it develops during the embryonic development of the iris, the cornea and the angle that exists between the two). It touches both eyes. Because of this, it is always serious. And it manifests itself from the first years which allows to intervene early and stabilize glaucoma so that there are no more consequences for the future.
Secondary glaucoma:
He intervened as follows:
Inappropriate and repeated intake of eye drops prohibited in well-defined cases (in particular cases of cortisone eye drops).
Eye disorders (repeated infections, lens lesions, trauma).
Vascular disorders (increased pressure in the veins in the eye).
The symptoms are identical to those of primary wide-angle glaucoma.
************** /////////////////// ***************** *************************************
Laser and ultrasound for glaucoma:
What is laser?
The laser (short for "Light Amplification by Stimulated Emission of Radiation") is an extremely powerful and concentrated beam of light whose energy allows the cutting or burning of human tissues.
The laser is an ideal instrument because the eye is formed of transparent structures that allow the light emitted by the laser to pass well.
The main advantage of the laser is that it is possible to perform eye surgery without any incision, which eliminates the risk of infection and limits the risk of ocular bleeding.
The nature of the gas (argon, Yag) used to concentrate the light ray delivered by the laser characterizes the laser.
Laser surgery is often painless and does not cause any scarring visible to the naked eye. It is not necessary to hospitalize the patient for the laser because the operation is carried out under simple local anesthesia.
Sometimes, it can be responsible for a discrete inflammation, often transient and well controllable by local anti-inflammatory treatment.
Source: Société Française du Glaucome - 2011
YAG laser for iridotomy
Source: Société Française du Glaucome - 2011
The laser for acute glaucoma:
In acute angle-closure glaucoma, the iris blocks the intra-ocular circulation of the aqueous humor, which is the liquid that gives the eye its tonicity. The iris, which gives color to the eye, is the diaphragm that modulates the amount of light that reaches the retina.
The laser that treats acute glaucoma is the YAG laser and is used to make an orifice in the iris. The procedure is called "laser iridotomy". The patient is installed on a machine that delivers the laser beam and the doctor focuses several laser strikes at the same spot, in order to make the hole in the iris.
Source: Société Française du Glaucome - 2011
Laser Iridotomy: the hole made
Laser is for the peripheral part of the iris
During the entire procedure, the patient must remain immobile because an unwanted movement of the eye could be harmful. However, the procedure is usually simple and can treat acute glaucoma in one session. In some cases, fortunately rare, the laser proves to be ineffective in piercing the iris: it is then necessary to operate the patient to perform the surgical procedure called "iridectomy".
The laser for chronic glaucoma:
The laser that treats chronic glaucoma is the argon laser (or similar laser that delivers a light ray of the same frequency). In chronic glaucoma, the increase in ocular pressure is due to a decrease in the porosity of the trabeculae.
Ocular hypertonia usually occurs gradually, painlessly and therefore imperceptible to the patient. In chronic glaucoma, the laser is applied directly to the trabeculae, which contracts under the effect of heat: it is "laser trabeculoplasty".
After a few weeks, the doctor notices that the eye pressure has decreased, which then lighten the treatment followed by the patient. In some cases, trabeculoplasty is insufficiently effective and does not alter treatment.
In any case, it is necessary to monitor the patient, even long after trabeculoplasty, because the eye pressure often tends to increase with time.
The major interest of the laser in chronic glaucoma is its relative harmlessness and the possibility of repeating it if it has been effective for the first time. Moreover, it is always carried out under simple local anesthesia, without hospitalization.
The laser diode
The laser diode is another type of laser that is used in glaucomas resistant to conventional medical or surgical treatments. The goal of laser diode surgery is to destroy the ciliary processes, which form small glands behind the iris and have the role of secreting the aqueous humor.
The so-called "diode laser cycle destruction" is a rapid, repeatable but painful procedure, which explains the frequent use of local anesthesia by pitting.
The beam of the diode laser is applied to the surface of the eye via an optical fiber. The doctor directs the laser strikes to the ciliary processes to destroy them one by one.
The laser diode is generally only offered in the event of failure of conventional surgeries, and the patients who benefit from it often have already undergone several operations before the laser diode. In any case, the indication of cycle destruction must be prudent because the excessive destruction of the ciliary processes can lead to irreversible atrophy of the eye.
Source: Société Française du Glaucome - 2011
Diode Laser Cyclodestruction
The ultrasound
Cyclodestruction can also be performed using high intensity focused ultrasound. This recent technique, the fruit of a French innovation, can also be proposed and is a variant of traditional cycle destruction techniques, using high technology equipment.
The procedure was named UC3, for Cyclo Coagulation Circular by Ultrasound and can now be used routinely. Ultrasonic cycle destruction techniques are generally better tolerated and
0 comments:
Post a Comment