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Cyclodestructive Procedures in Glaucoma

Definition Surgical and laser procedures that ablate the ciliary body to lower intraocular pressure for treatment of glaucoma. Key Features Transscleral cyclophotocoagulation. Transscleral micropulse diode laser. Endoscopic cyclophotocoagulation. Associated Features Neovascular glaucoma. End-stage glaucoma. Combined cataract surgery and endoscopic cyclophotocoagulation. Hypotony. Chronic inflammation. Phthisis. Introduction Cyclodestructive procedures reduce intraocular pressure (IOP) by decreasing aqueous production through destruction of the ciliary epithelium. Historically these procedures have been…

Laser Trabeculoplasty and Laser Peripheral Iridectomy

Definition and Key Features Laser trabeculoplasty: laser treatment to the trabecular meshwork to enhance outflow of aqueous humor from the eye. Laser peripheral iridectomy: laser treatment to create a full-thickness hole within the peripheral iris to alleviate pupillary block. Associated Features: Laser Trabeculoplasty Typically performed with argon or a frequency-doubled neodymium:yttrium–aluminum–garnet (Nd:YAG) laser. Indicated for ocular hypertension, primary open angle, pigmentary, pseudoexfoliation, and select other open-angle…

Current Medical Management of Glaucoma

Definition Medical management of glaucoma is the lowering of intraocular pressure using eyedrops and/or systemic medications. Key Features Medications for the treatment of glaucoma (currently approved by the US Food and Drug Administration) include: Chronic treatment: Prostaglandin analogues (increase outflow): Latanoprost: Latanoprostene bunod. Bimatoprost. Travoprost. Tafluprost. Beta-blockers (decrease inflow): Nonselective: Timolol. Levobunolol. OptiPranolol. Carteolol. Selective: Betaxolol. α-Adrenergic agonists (decrease inflow): Brimonidine. Apraclonidine. Carbonic anhydrase inhibitors (topical…

When to Treat Glaucoma

Definition Patients should be treated when glaucomatous damage is detected or progressing, or if there is a high risk that such damage will occur. Key Features Multiple factors must be considered when deciding whether the patient is to be treated for glaucoma. The most important factor is confirming that the patient has glaucoma. Assessment for glaucoma must include measurements of optic nerve structure and function. Structure:…

Congenital Glaucoma

Definition Glaucoma in children less than 2 years of age can be subdivided into (1) primary congenital glaucoma, which is the result of isolated, abnormal development of the anterior chamber angle structures, and (2) secondary congenital glaucoma, either following infantile cataract surgery or those associated with ocular or systemic syndromes. Key Features Elevated intraocular pressure. Glaucomatous optic atrophy (optic nerve cupping). Ocular enlargement (“buphthalmos”). Associated Features…

Glaucomas Secondary to Abnormalities of the Cornea, Iris, Retina, and Intraocular Tumors

Definition A diverse group of secondary glaucomas, either open or closed angle, caused by specific abnormalities of the anterior and/or posterior segment. The open-angle varieties include ghost cell hemolytic glaucoma and Schwartz’s syndrome. The closed-angle glaucomas include the iridocorneal endothelial syndromes, Axenfeld–Rieger syndrome, epithelial downgrowth and fibrous ingrowth (proliferation), aniridia, and intraocular tumors. Other conditions feature either mixed or nonspecific mechanisms of elevated intraocular pressure, such…

Malignant Glaucoma

Definition Aqueous misdirection, or malignant glaucoma, is a rare form of glaucoma that typically occurs postoperatively in patients with primary angle closure and is characterized by elevated intraocular pressure with a diffusely shallow or flat anterior chamber despite a patent iridotomy. Key Features Shallowing or flattening of both the central and peripheral anterior chamber despite patent iridotomy. Typically associated with markedly elevated intraocular pressure. Usually occurs…