treatment for angle closure glaucoma
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Treatment for Angle
Closure Glaucoma
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Penatalaksanaan :
1. Medikamentosa
2. Laser
3. Operatif
Medikamentosa sama dgn POAG
Laser meliputi laser iridotomy, laser gonioplasty
atauperipheral iridoplasty
Tindakan bedah yaituperipheral iridectomy,
filtering surgery, cataract extraction, chamberdeepeningdan goniosynechialysis
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Medical Treatment
Pengobatan PACS
Laser iridotomy profilaksis
Jika Iridocorneal contact tetap berlangsung
setelah laser iridotomy, pengelolaan selanjutnyadgn observasi, Laser iridoplasty, profilaksis
dengan pilocarpine 1% dan ekstraksi lensa
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Medical Treatment
Tujuan Pengobatan APAC
- Menurunkan TIO dgn cepat, mencegah
kerusakan optic nerve lebih lanjut
-Mengurangi edema pada kornea
-Mengurangi reaksi inflamasi
-Mencegah konstriksi pupil-Mencegah terbentuknya sinekia posterior
danperipheral anterior synechia (PAS)
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Medical Treatment
Pengobatan APAC:
terapi : Acetazolamide 500 mg (IV)
dilanjutkan
oral 500 mg
bloker topikal
Steroid topikalmenekan
inflamasiAnalgetik dan anti emetik
Pilocarpine ED 2 - 4%
Gliserol 50 % 1 gr/kgBBManitol 20% 1-2 r/k BB
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Surgery Treatment
Laser Iridotomy :
Indikasi:
Blok pupilProfilaksisPACS
Laser peripheral iridotomy (LPI)24-
48 jam setelah TIO terkendaliSecondary angle closure glaucoma
Incomplete surgical iridectomy
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Kontra Indikasi :
Terdapat rubeosis iridis-->bleeding
Penggunaan obat2an antikoagulanKornea tidak jernih
COA yang sangat dangkal
IritisPupil dilatasi
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Surgery Treatment
Teknik :
-Argon laser : utk membuat lubang di iris, iris ygterlalu gelap atau terang merupakan suatu penyulit
-Menggunakan condensing contact lens-Setting : 0,02-0,1/detik, 50m spot size, 800-
1000mW
-Komplikasi : lens opacity, acute rise in IOP,
transient or persistent iritis, early closure ofiridectomy, posterior synechia, corneal & retinal
burn
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Surgery Treatment
Laser Gonioplasty or Peripheral Iridoplasty :
Indikasi :
-plateau iris syndrome
-narrow angle after laser peripheraliridotomy
-nanophthalmos
-microphthalmos-angle closure glaucoma (ACG), and/orperipheral anterior synechiae
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Surgery Treatment
Nd Yag laser:
Fewer pulses, less energy
Keefektifannya tdk dinilai dari warna irisIridotomy tdk cepat menutup
Menggunakan condensing lens, laser uk. 2-
8mJ
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Surgery Treatment
Komplikasi :
- Corneal burns
- PAS atau sinekia posterior- Peningkatan TIO pasca laser
- Inflamasi
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Surgery Treatment
Kontra Indikasi:
Hampir sama dgn laser iridotomy
Technique:laser setting : 0,1-0,5 detik, 200-500m
spot size, 200-500m.
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Surgery Treatment
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Surgery Treatment
Incisional surgery :
-Peripheral iridectomy : dilakukan bila dgn
laser tdk mencukupi, kornea yg edema,
COA yg datar, dan pasien tidak kooperatif
-Ekstraksi katarak : blok pupil yg tjd krn
katarak, ekstraksi katarak dianggap sbg
prosedur utama
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Surgery Treatment
Chamber deepening and goniosynechialysis
:
- Ketika tjd PAS dan iridectomy tdk cukup
adekuat
- Pendalaman anterior chamber
- Viscoelastis/ iris/ cyclodialisis spatula sgtberguna sbg prosedur goniosynechialysis --
> melepaskan synechia
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Other Procedures to Lower IOP
Aqueous shunt:
-Secara umum tube yg diletakkan pada
anterior chamber, sulcus ciliaris, atau
melalui pars plana msk kdlm vitreous.
-Ukuran biasanya bervariasi shg dpt
mempengaruhi kontrol TIO dan komplikasi
post.op
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Other Procedures to Lower IOP
Indikasi :
-Gagalnya trabeculectomy with antifibrotics :menjadi pilihan apabila tdk memungkinkan
utk melakukan pengulangan trabeculetomy-Uveitis yg aktif : keberhasilan melakukantrabeculectomy biasanya rendah, shg dipilih
dgn aqueous shunt
-Glaukoma neovaskular: risiko tinggi utkkegagalan trabeculectomy
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Other Procedures to Lower IOP
Kontra Indikasi :
-Kondisi endotel cornea.
Pre op :-Hampir sama dgn trabeculectomy.
-Perhatikan gerak bola mata, sclera, apakah
ada PAS, dan lokasi vitreous.
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Other Procedures to Lower IOP
Technique :
-Kuadran superotemporal lbh dipilihdibandingkan superonasal --> lbh mudah.
-Shunt hrs dlm posisi baik
-Extraocular plate dijahitkan pada posisivertikal&horizontal pada m.rectus posterior k
insersi musculus.-Tube kmdn diarahkan anterior utk
memasuki sudut atau melalui pars plan.
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Other Procedures to Lower IOP
-Shunt hrs tertutup sclera utk mencegaherosi
Post op.management:
-Topical corticosteroid, antibiotics andcycloplegics
Complication :
-Overfiltration
-Corneal decompensation dkt dgn shunt
-Erosi shunt
-Gangguan gerak bola mata
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Other Procedures to Lower IOP
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Other Procedures to Lower IOP
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Other Procedures to Lower IOP
Ciliary Body Ablation Procedures
Indikasi :
-Menurunkan IOP pada mata dgn visus yg jelek .
-Incisional surgery pada mata yg mengalami
kebutaan sebaiknya dihindari krn berisiko utk
oftalmia simpatika
-Diode Laser Cyclophotocoagulation (CPC) srgmenjadi pilihan utk menurunkan IOP pada mata
buta yg tidak berespon dgn terapi lain
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Other Procedures to Lower IOP
Contraindication:
-Mata dgn visus yg baik krn akan ada risikokehilangan penglihatan
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Other Procedures to Lower IOP
Methods :
-Cyclocryotherapi & Nd Yag Laser
-CPC lebih baik krn sakit dan inflamasi yg tjdminimal.
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Other Procedures to Lower IOP
Post op:
-Adequate analgesic trmsk narcotic segera
stlh post op
Complication :
-Prolonged hypotony, pain.
-Inflamasi, CME.-Perdarahan bahkan pthisis bulbi.
-Oftalmia simpatika.
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Other Procedures to Lower IOP
Cyclodialisis:
-Membuat hub.antara anterior chamber dgn
daerah suprachoroidal,
-Bs tjd krn trauma atau operasi.
-Jarang dilakukan saat ini.
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Other Procedures to Lower IOP
Prosedur :
-Spatula masuk melalui daerah
suprachoroidal ke anterior chamber melalui
incisi sklera 4mm posterior dari limbus.
Komplikasi :
-perdarahan, inflamasi, Descemets
detachment.
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Other Procedures to Lower IOP
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TERIMA KASIH