html5-img
1 / 22

EBM Case Discussion

EBM Case Discussion. Supervisor: Dr. 蘇蔚文 Speaker: R1 林子瑜. Case. name: 顧劉 x 桃 No.: 20992840 age: 73 F. Chief complaint (99.8.25). Blurred vision OU. Glaucoma was diagnosed 2 months ago, cosopt use. Past history. OPH history: OP (-), trauma (-)

thiery
Download Presentation

EBM Case Discussion

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. EBM Case Discussion Supervisor: Dr.蘇蔚文 Speaker: R1 林子瑜

  2. Case • name: 顧劉x桃 • No.: 20992840 • age: 73 F

  3. Chief complaint (99.8.25) • Blurred vision OU. Glaucoma was diagnosed 2 months ago, cosopt use.

  4. Past history • OPH history: OP (-), trauma (-) • Right middle cerebral artery territory infarction with left hemiplegia, dysphagia and neurogenic bladder (since 99.2.11 ) • Left leg deep vein thrombosis (under warfarin therapy )

  5. Examination of eye • VA: OD:L-S(+), OS:HM/100CM • PT : OD:28.3mmHg ,OS:21.9mmHg Eyelid : clear OU conea: clear OU anterior chamber: shallow OU Lens: OD NS (+++) CO (+++) OS NS (+++) CO (+++) Fundus disc OD pale, C/D 0.8x0.9 inferior no rim OS pinkish, C/D 0.7x0.7

  6. Course and treatment(99.8-100.3) • drug • 1:cosopt 3:cosopt ,alphagan, xalatan 4:cosopt ,alphagan, xalatan,diamox OP day

  7. 2011. 1. 18 phacoemulsification and of intraocular lens implantation(OU) • 2011.1.27 VA : OD: CF/60cm, OS: 0.04

  8. Impression 1. Chronic angle closure glaucoma, OU 2. Senile cataract , OU post phacoemulsification and of intraocular lens implantation

  9. Discussion lens extraction in chronic angle closure glaucoma

  10. Mechanisms in Angle-closureGlaucoma • pupillary block mechanism • angle crowding: plateau iris configuration

  11. Pathogenesis of Angle-closureGlaucoma and the Role of the Lens • Mean anterior chamber depth in PAC eyes is approximately 1.8 mm. • factor related to angle closure - lens thickness - anterior position of the lens

  12. Change after cataract surgery • anterior chamber depth angle opening distance at points 500 µm from the scleral spur trabecular–ciliary process distance • attenuate anterior positioning of the ciliary processes • widen of the angle Ophthalmology 2006;113:437–441 c 2006 by the American Academy of Ophthalmology

  13. Intraocular pressure reduction with cataract surgery • No evidence to suggest that more efficient removal of lens material have had any significant impact on the postoperative IOP . Current Opinion in Ophthalmology 2010, 21:118–122

  14. In glaucoma patients • vary with glaucoma diagnosis which related to preoperative angle anatomy • Chronic angle closure glaucoma - Hayashi et al. in 2001, larger percentage of patients with CACG (40.0%) did not require glaucoma medications postoperatively relative to those with POAG (19.1%). - Lam and Hata in 2008 demonstrated 2.4 - 2.8mmHg additional decreases in IOP for cataract surgery patients as compared with those undergoing LPI alone.

  15. the effect of post cataract surgery - increase postoperative aqueous outflow facility - trabecular meshwork cells release interleukins and tumor necrosis factors, which increase synthesis of matrix metalloproteinases

  16. Clinical studies lens extraction for angle closure glaucoma (1988-2007)

  17. Survey of ophthalmology March to April 2009

  18. Conclusion • Lensectomy and PCIOL implantation for ACG patients may offer successful IOP control, and maintenance of improved vision. • There is no evidence from good quality randomized trials of the effectiveness of lens extraction for CACG.

  19. Thanks for listening!!

More Related