7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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SOME DILEMAS IN CHRONIC
OPEN ANGEL GLAUCOMATREATMENT
Ilhami Goranci, Ardiana Goranci Baruti,Dafina Goranci Rexhebeqaj,
Halil Ajvazi, Dardan Goranci
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Glaucoma
Is a disease of progressive opticneuropathy with loss of retinal neuronsand the nerve fiber layer,resulting inblindness if left untreated.
Is a third leading cause of blindess inthe world.
Affects about 13,5 milion people allover the world,and around 6,7 milons ofthem are blind.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Most common type of glaucoma is
chronic primary open angleglaucoma(POAG).
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Risks factors in POAG Age
-prevalence ranges around 15%in those older than 70 years
Family history
-when one parent suffer from glaucoma,risk increases up to to 2..2times
Chronic systemic diseasses
-diabetes-cardiovascular disease
Eye disorders
-corneal thickness
-pseudoexpholiations
-myopia,hypermetropia
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Diagnosification
Gold standards tests
-Tonometry
-Perymetry
-Optic disc examination-Gonioskopy
-Daily tonometric curve
The newer tests
-Nerve fibere layer analyzers(GDX,OCT,HRT)-Ocular blod flow measurment,and
-Ultrabiomicroskopy(UBM)
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Therapeutic modalities for POAG
Medicationfirst line of treatment Laser (SLT,ALT)
Surgery treatment
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Medical therapy
POSITIVE IMPACT
drops carries the least risk
NEGATIVE IMPACT
Side effects of effective drops Allergy to presrvatives
Several medication
Life long regiment(especialy to young patients 40-
60 years) Patient quality of life
Expense of treatment
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Treatment of CHPOAG has thisperformance
Aplications of B-blockers
-IOP controlled> 21mm Hg - failure
+Vazoprotektor+Neuroprotektor alternate monotherapy
a-agonist,PG,CAI
- failure
Surgery
Continue treatment,
Reviw every 3-6 months
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Surgical therapy
POSITIVE IMPACT
More cost effective than life time medication.
Patient do not have daily phsycological burden of
treating the disease.
NEGATIVE IMPACT
Invazive method.
In and post operative complications. After surgery IOP is not always normalised.
Continuing glaucoma damages.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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THERAPY DESSISION FORGLAUCOMA
Treating glaucoma is difficult decision of both theopthalmologist and patients,especialy in somespecific situations.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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DIFFICULT SITUATTIONCOMMON FOR OUR CASES
Patient unable to afford treatment
(fullcost of medical care is on paient)
Absence of free preservative drops in our country. Problem with self administration of drops
(absence of social service)
Our experience shows that 50% of patients do notuse their drops as prescribed
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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The goal of glaucoma treatment is to preserve thevisual field of patient and prevent the loss of visualfunction that is associated with the disease.
Our target in presented cases was to get the pressurewell kontrolled by medication or surgery.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Materials and methods
We undertook our study to review ourPrivate Practice in Prishtina andRegional hospital in Prizren experiencein CHPOAG treatment success.
15.362 pacient were enroled in ourstudy between 2006-2009.
486 of them were with glaucoma146 with POAG.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Number of treated patients
0
50
100
150
200
250
300350
400
450
500
486 (3.2%)
146(29%)
Graf.1 Total patient no.
with
glaucoma
with
CHPOAG
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Number of patient with CHPOAG types
0
10
20
30
40
50
60
70
80
90 82(56%)
61(42%)
3(2%)
With glaucoma
simplex
Glaucoma
capsulare
Glaucoma
Pigmentos.
Graf.2.
Total no 146
(100%)
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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From 146 patient with CHPOA compensation of IOPafter medical therapy was
-74(from 82 cases with Glaucoma simplex)
-53(from 61cases with glaucoma capsulare),
and
-2(from 3 cases with Glaucoma pigmentosum)
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Compensation of IOP after medical therapy
0
10
20
30
40
50
60
70
80
-Glaucoma
simplex 82
cases
-Glaucoma
capsulare
-Glaucoma
pigmentosum
74(90.2%)
53(88.5%)
8(9.8%) 8(11.5%)
2(67.0%) 1(33.0%)
Graf.3 Comp. Not comp. Comp. Not comp. Comp. Not comp.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Percentage of medical and surgicaltreatment
From 146 patients with CHPOAG-102 were medical treated
-32 were surgical treated
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Percentage of medical and surgicaltreatment
0
20
40
60
80
100
120
140
Graf.nr 4.
total 146(100) Medical treated Surgical treated
.
102(76.8%)
32(23.2%)
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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We did selected four cases for ourpresentation.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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First case I.D., 61 y.
OD OS
Dg. Glaucoma.caps.Invet.
decompens.
Glaucoma caps. inic.
VO,TO,dh FO 0.10/60 42 mmHg,E 0.9 D.IV.
1.0, 22 mmHgE 0.2. D.I
Asimetric
glaucoma
Gonioskopy Open angel,light pigment. Open angel,light pigment.
VF Its not determinated With inicial damages
Right eye is
operated
Dg.Gl.caps.
subcomp
After operation
Gla.cap.invet.subcompe.
-.Xalatan -Xalatan
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Second case V.C., 66 vj
OD OS
Dg. Glaucoma caps.inic..compens..
Gl.capsul.init.subcom.
VO.TO.
FO
1.0, 19 mmHg,E 0.4, D.I-II.
1.0, 24 mmHg,E 0.4, D.II.
Asimetrik glaucoma
Gonioskopy Open angel,light
pigment.
Open angel,light
pigmented.
VF Initial damages Initial damages
After medicaltherpyIOPwas normal.TO
Patient is on foolow up
-.Trusopt
-.Xalatan
18 mmHg
-.Trusopt
-.Xalatan
16 mmHg
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Third case SH.M.,61vjet
OD OS
Dg Hyperopia et gl.caps.init. subcomp.
Hypertensio bulbi
VO,TO,FO 0.9cc, 23 mmHgE O.4 D.I-II
1.0sc ,22 mmHg,E.0..2 D.I
Asimetric gl.Gonioskopy
FV
Open angel
Initialdamages
Open angel.
No damages
After medical
therapy IOP isnormalised
-Timolol 0.5% -Timolol 0.5%
TO
Patient is followed
upforfive years
18 mmHg 16 mmHg
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Fourth case M.K., 70 y
OD OS
Dg Gl.simlex.inic.subcomp.
St.posthaemor.cent.retine.
VO,TO,FO 0.9sc, 25 mmHgE.O.4, D.II.
0.3sc, 17mmHg,E.O.2 ,D.I.
Gonioskopy Open angel Open angel
V F
Asimetris glaucoma
After treatment IOP
was normalised
Initial damages
Timolol 0.5%
Trusopt
With no damages
TO 15 mmHg 17 mmHg
Patient is followed up
for 4 years
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Discusion
In 114 of our cases with POAG treated with medicaltherapy we did get the pressure well controlled.
We did perform operation in 32 of patient.
In 20 cases despite our best efforts IOP remainsdecompensated.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Cairns(1972) reported 48% controlled with adrainage bleb.
Cvetkovic reports 5% operated pacients from all his
cases.
Retrospective study(P.Ehnroth) demonstarted that50% of eyes initially treated with medicationsrequired surgical intervention.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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Conclusion
Therapy for glauocoma can be effective only ifpatient fill their prescription and take theirmedication as directed
With good patient compliance with drops andregular follow up ,their glaucoma is kept stable formany years,althought in some patients glaucomamay progress, despite best efforts.
7/29/2019 Chronic Glaucoma Treatment / SEEOS / Tirane / 18-06-2010 / Prof.dr.Ilhami Goranci , Dr.Ardiana Goranci , Dr.Dafina Goranci , Dr.Halil Ajvazi, Dr.Dardan Goranci.
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THANK YOU FORYOUR ATTENTION
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