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    Glaucoma

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    GLAUCOMA
    1. What Is Glaucoma?
    2. What Is The Normal Intraocular Pressure?
    3. Is Corneal Thickness Related To Intraocular Pressure?
    4. What Are The Causes Of Glaucoma?
    5. How Many Types Of Glaucoma Are There?
    6. How Often And How Should Individuals With A History Of Glaucoma In First-Degree Relatives Be Followed Up?
    7. How Is Glaucoma Diagnosed, Which Tests Are Performed?
    8. How Is Glaucoma Treated?
    9. SLT (Selective Laser Trabeculoplasty)

    Glaucoma is a condition in which permanent optic nerve damage occurs due to intraocular pressure. This condition is usually realted to high intraocular pressure.

    The fluid in the eye (aqueous humour) is produced from the ciliary body inside the eye, passes behind the pupil to the anterior part of the eye and is normally drained from the eye through a drainage system called the trabeculum.

    Glaucoma usually occurs when the drainage of the fluid in the eye is blocked or reduced. In this case, the fluid in the eye drains more slowly than normal. As a result, the intraocular pressure increases.

    High intraocular pressure leads to compression of the blood vessels in the optic nerve and impaired nutrition of the optic nerve fibers. This leads to damage to the optic nerve fibers and impaired transmission of visual information from the optic nerve fibers to the brain. If glaucoma is not controlled, progressive optic nerve damage can lead to permanent vision loss and even blindness.

    The normal value of intraocular pressure, i.e. eye pressure, is 10-21 mmHg.

    Yes, it is. If corneal thickness exceeds 550 microns, intraocular pressure should be calculated accordingly.

    • Disorders in the intraocular fluid drainage system: Normally, fluid is produced in the eye and drained from the eye through the drainage system. Blockages or obstructions anywhere in this system can make it difficult for the fluid to drain, leading to increased pressure inside the eye.
    • Genetic factors: Glaucoma is more common in people with a family history. This suggests that genetic factors may play a role in the development of glaucoma.
    • Aging: Aging can increase the risk of glaucoma. With age, the fluid drainage system in the eye may be affected, contributing to the development of glaucoma.
    • Other health conditions: The presence of systemic diseases such as hypertension may increase the risk of glaucoma by increasing eye pressure.
    • Eye trauma or surgery: Eye trauma or previous eye surgery can affect the anatomical structure within the eye and trigger the development of glaucoma.
    • Primary Open Angle Glaucoma
    • Normal Pressure Glaucoma
    • Primary Angle Closure Glaucoma
    • Pseudoexfoliative Glaucoma
    • Pigmentary Glaucoma
    • Neovascular Glaucoma
    • Inflammatory (Uveitic) Glaucoma
    • Glaucoma Related to the Lens of the Eye
    • Traumatic Glaucoma
    • Ocular Hypertension

    PRIMARY OPEN-ANGLE GLAUCOMA:

    It is the most common type of glaucoma. It occurs in 1% of the general population over the age of 40. Patients are equally distributed among both sexes.

    Risk Factors:

    • Age: It is most common in people over the age of 65.
    • Race: It is more common in blacks than whites.
    • Family History: It is more common in those with a family history of primary open-angle glaucoma.
    • Myopia: It is more common in myopes.
    • Retinal Diseases: It is more common in patients with central retinal vein occlusion, rhegmatogenous retinal detachment and night blindness.

    PRIMARY ANGLE CLOSURE GLAUCOMA AND ITS IMPORTANCE:

    Angle-closure glaucoma is a glaucoma caused by a sudden and severe increase in intraocular pressure that requires emergency intervention. Normally, the fluid inside the eye drains out of the eye. However, in angle-closure glaucoma, the fluid in the eye cannot drain out normally because the angle between the iris (the part that gives the eye color) and the cornea closes. This leads to increased intraocular pressure and damage to the optic nerve fibers.

    Angle-closure glaucoma can emerge with symptoms such as sudden and severe eye pain, blurred vision, sensitivity to light and sometimes nausea and vomiting. These symptoms may require urgent medical attention.

    • The treatment of angle-closure glaucoma is usually done in the following ways:
    • Emergency Intervention: During an acute crisis, medications can be used to quickly lower the patient's intraocular pressure. These medications are usually administered in the form of drops or injections.
    • Laser Treatment: A common method of treating angle-closure glaucoma is a laser procedure called peripheral iridotomy. This procedure creates a small hole in the iris, which increases the drainage of fluid inside the eye.
    • Surgical Intervention: In chronic or recurrent cases, surgical procedures may be required. For example, a surgical procedure called trabeculectomy is intended to improve the drainage system within the eye.

    INFLAMMATORY (UVEITIS-RELATED) GLAUCOMA:

    Uveitic glaucoma is a type of secondary glaucoma associated with an inflammatory condition of the eye called uveitis. Uveitis is an inflammatory condition of the iris and surrounding tissues in the front part of the eye that directs light to the retina. This inflammation can increase intraocular pressure, which can lead to the development of glaucoma.

    Uveitic glaucoma is a complication of uveitis in which uveitis increases intraocular pressure, leading to the development of glaucoma. The increase in intraocular pressure can put pressure on the optic nerve fibers, causing vision loss.

    Symptoms of uveitic glaucoma can include symptoms of both uveitis and glaucoma. These may include the following:

    • Eye Pain: Feeling of severe or uncomfortable eye pain can be seen in many cases of uveitis.
    • Redness and Swelling: Redness and swelling of the eye are symptoms of uveitis.
    • Blurred vision: Images are not clear due to inflammation.
    • Light Sensitivity: Increased sensitivity to light.
    • Symptoms due to increased intraocular pressure: Symptoms of glaucoma such as headache, blurred vision, pain or a feeling of pressure in the eye.

    Treatment of uveitic glaucoma may include treating both uveitis and glaucoma. Treatment is usually aimed at lowering intraocular pressure, controlling inflammation and protecting the optic nerve fibers. This treatment is usually achieved with a variety of medications, such as eye drops, oral medications, steroid injections or anti-inflammatory drugs.

    Measurement of eye pressure, visual field examination, OCT (Optical Coherence Tomography) and ophthalmoscopy are performed during follow-up.

    Individuals with a history of glaucoma in first-degree relatives should be screened from the age of 40. Provided the initial evaluation is normal, subsequent examinations should be performed at 2-year intervals until the age of 50 and then annually thereafter.

    After asking about the patient's complaint, a good family history should be taken and it should be questioned whether first-degree relatives in the family have glaucoma. Visual acuity should be checked. If there is low vision, the cause should be investigated. Biomicroscope (slit lamp) should be used to look at the eye and evaluate whether there are signs of eye pressure. The angle should be examined with a gonioscope and the type of glaucoma should be determined. Eye pressure should be measured with an applanation tonometer and the optic nerve head should be evaluated with fundus examination. Pachymetry should be measured and corneal thickness should be checked. Visual field and OCT tests should be performed for diagnosis and follow-up.

    • Visual Field Test: It is a test used in the diagnosis and follow-up of eye pressure. The patient first closes one eye and is told not to move it while looking at a fixed point. Light is sent to the hemispherical screen from different directions and with different intensities. The patient is asked to press the button at the first moment he/she notices them. The results are recorded on a computer, printed out and the disease is diagnosed. The same procedure is performed for the other eye. This test is repeated every 6 months or a year.
    • OCT (Optical Coherence Tomography): This is a medical imaging technique used to visualize the structures inside the eye in detail. This technology provides ophthalmologists with information about the retina, optic nerve fibers and other important structures of the eye. OCT can image microscopic structures within the eye in high resolution, making it an important tool in the diagnosis and monitoring of eye diseases.

    The OCT device is based on the principle of interferometry. By sending light to a target and receiving the reflected or scattered light, information about the internal structure of the target is obtained. The optical properties of the tissues within the eye affect the reflection or scattering of light from these tissues. By analyzing these reflections or scattering, OCT images the internal structure of the eye.

    The areas of use of OCT are as follows:

    • Retinal Diseases: OCT is widely used for the diagnosis and follow-up of diseases such as macular degeneration, retinal tears and retinal edema.
    • Glaucoma: It can help diagnose glaucoma and monitor its progression by assessing the thickness of optic nerve fibers and the structure of the retinal layers. Thanks to its ability to acquire high-resolution images, OCT provides ophthalmologists with important information for early diagnosis of diseases and determining the treatment plan. This means better outcomes for patients and more effective treatments.

    The treatment of glaucoma can vary, depending on the type and severity of the disease and individual factors. Glaucoma treatment is usually aimed at controlling intraocular pressure and reducing pressure on the optic nerve fibers, thus protecting the optic nerve. Treatment methods include the following:

    • Eye Drops: Prescription eye drops are used to lower intraocular pressure. These drops usually increase the drainage of intraocular fluid or decrease the production of fluid in the eye.
    • Oral Medications: In some cases, eye drops may not be enough and oral medications may be prescribed. These medications usually help to lower intraocular pressure.
    • Laser Procedures: Procedures such as laser trabeculoplasty (SLT) or laser iridotomy can be used to lower intraocular pressure. These procedures are generally less invasive than surgical procedures and may be preferred.
    • Surgical Intervention: Surgical intervention may be needed in some cases to control intraocular pressure. Trabeculectomy or other surgical procedures aimed at improving the drainage system within the eye fall into this category.
    • Combined Treatments: In some cases, more than one treatment method may be used together. For example, eye drops and laser procedures can be used together.

    Treatment options may vary depending on the type and progression of the disease. Early detection and treatment of glaucoma is vital to slow or stop the progression of vision loss. Therefore, it is important to have regular eye examinations and monitor symptoms.

    It is a laser treatment method used to reduce intraocular pressure. It is especially applied in cases of high intraocular pressure such as open-angle glaucoma. SLT is a type of laser that acts selectively on the trabecular meshwork (drainage system) inside the eye.

    The working principle of SLT is that the laser light acts on the trabecular meshwork within the eye, creating microscopic holes to increase its drainage capacity. These holes allow intraocular fluid to flow more freely and thus lower intraocular pressure.

    The advantages of SLT are:

    • Selective Effect: Compared to other laser treatment methods, SLT acts more selectively on tissues within the eye. This ensures that healthy tissues are not damaged and side effects are reduced.
    • Repeatability: SLT can be repeated as needed. In other words, it can be reapplied when the effect wears off or when the intraocular pressure increases again.
    • Low Risk of Side Effects: Compared to other laser treatments, SLT has a lower risk of side effects.

    SLT is usually preferred when other treatments to lower intraocular pressure are ineffective. This treatment reduces the number of medications for people taking multiple eye pressure medications.

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