opthalmology

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opthalmology

Macular Degeneration

possible to slow down the "wet" form

two forms

wet

abnormal vascularization

dry

atrophy and scarring

common

affects center of the visual field

Damage to retina

mitochondrial dysfunction may play a role

Oxidative stress

loss of photoreceptors

Age Related Macular Degeneration

Anatomy

Anterior Chamber

Posterior Chamber

Cataract

Treatment

AGE bodies stick to lens?

Surgery

endophthalmitis

retinal detachment

Intracapsular Cataract Extraction (ICCE)

complications

Manual Small Incision Cataract Surgery

popular in developing countries w/out access to phacoemulsification

incision very large

remove the lens through a scleral tunnel wound

Extracapsular Cataract Extraction (ECCE)

when emulsification is problematic

remove the lens manually, leave capsule intact

Phacoemulsification

a plastic lens is inserted instead

use ultrasound to to emulsify or turn the lens into liquid, and then suck it away

Capsulorhexis

circular hole in the capsule where lens sits

to replace cloudy lens

Clouding of the lens

Glaucoma

mechanism

All types of optic neuropathy

visual field reduced

vision loss irreversible

Ciliary processes

Aqueous humor

drained by trabecular meshwork

most people, with treatment, will not lose their sight

IOP

Optic nerve cannot tolerate high pressure

above 2.8 kPa

loss of retinal ganglion cells

Intraocular Pressure

ocular hypertension

treatments

alternatives

Canaloplasty

ocular version of angioplasty

extremely fine catheter to clear the drainage canal

improve aqueous circulation through the trabecular outflow

Trabectome

reduce resistance to outflow of aqueous humor

uses heat to warm up the trabecular meshwork

a probe

in anterior chamber through the cornea

ExPress mini glaucoma shunt

in anterior chamber, under the scleral flap

stainless steel device

surgery

Nonpenetrating

not as effective at trabeculoctomy

requires greater surgical acumen

doesn't enter anterior chamber

newer

Drainage implant

preferred in some cases

scar tissue, etc.

less efficient than trabeculoctomy

a silicone tube extends into the anterior chamber

Trabeculectomy

flap allows fluid to escape

passage in the sclera

white of eye

open & closed angle

when laser/pills don't work

laser surgery

Cycloablation

Endoscopic Cyclophotocoagulation (ECP)

instrument is placed inside the eye to apply energy directly to the ciliary body tissue

Transscleral cyclophotocoagulation

go through the outer sclera

for elevated IOP after other treatments failed

reduce aqueous humor by destroying part of ciliary body, which produces the fluid

open-angle glaucoma

Laser Peripheral Iridotomy (LPI)

Helps with pupillary blockage

Make an opening through the iris

lets aqueous fluid flow from behind the iris to the anterior chamber of the eye

for angle-closure glaucoma

Trabeculoplasty

types

Selective Laser Trabeculoplasty (SLT)

May be done multiple times

leaves much of the meshwork intact

Uses very low levels of energy

Argon Laser Trabeculoplasty (ALT)

increase drainage flow

ALT is successful with 75% of patients

half of the meshwork is treated first

treat trabecular meshwork of the eye

for open-angle glaucoma

focus on the drain so that aqueous fluid can pass easily out of the drain

results in a few weeks

takes 10-15 minutes

most common

for open angle glaucoma

medication

Carbonic anhydrase inhibitors

Miotics

Pilocarpine

Adrenergic agents

Beta blockers

side effects

Prostaglandin analogs

Travoprost (Travatan)

Bimatoprost (Lumigan)

Latanoprost (Xalatan)

pills

eye drops