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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 (-)

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EBM Case Discussion

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  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!!

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