0311-

Size: px

Start display at page:

Download "0311-"

弗孙
5 years ago
Views:

1 實習生施盈伃 1

2 *Introduction *Pathogenesis *Epidemiology *Risk factors *Classification *Diagnosis *Therapy *Summary 2

3 *Optic neuropathy in 1 or both eyes characterized by structural damage to optic nerve associated visual dysfunction *Disease not always associated with presence of raised intraocular pressure(iop) 3

4 眼房水眼房水 4

5 Progressive damage to retinal ganglion cells, axons and deformation of connective tissues supporting optic disc Mid-peripheral visual field loss, as retinal ganglion cells damage selectively more Rapidly in axons passing through upper and lower poles of optic disc Loss of central visual acuity and temporal visual field with progression to end-stage disease 5

6 6

7 正常幾乎沒有症狀初期中期晚期 7

8 *Glaucoma is the second leading cause of blindness in the world * Among people age 40 to 80, in 2013, there were an estimated 44 million people with open-angle glaucoma worldwide, and that this number will increase to 53 million by 2020 *Open-angle glaucoma European or African descent Angle-closure glaucoma Asian descent 8

9 Age Race Family history Elevated intraocular pressure (IOP) Hypertension Diabetes Other factors 9

10 *Age The incidence of OAG increases significantly with age. 55y 1% 65y 2% 80y 4% The rate of blindness from open-angle glaucoma also increases with age 台灣 : 40y 罹患青光眼約為 1%,5-10% 眼壓過高 *Race Three times higher in blacks, compared to whites 10

11 *Family history the relative risk of open-angle glaucoma increased 3.7- and 2.2-fold for individuals with an affected sibling or parent. *Elevated intraocular pressure (IOP) normal range:8-22mmhg neither necessary nor sufficient for the diagnosis 11

12 Open-angle glaucoma Angle-closure glaucoma Developmental glaucoma Primary Secondary Primary Secondary Acute Chronic 12

13 *Progressive, chronic optic neuropathy in adults in which intraocular pressure and other currently unknown factors contribute to damage. * Characteristic: atrophy of the optic nerve loss of retinal ganglion cells and their axons. 13

14 杯盤比 (Cup-to-Disc ratio, C/D ratio) 數值越高表示視神經受損越嚴重 14

15 Clinical findings characteristic of POAG Evidence of optic nerve damage Adult onset Open anterior chamber angles Optic disc or retinal nerve fiber layer structural abnormalities Reliable and reproducible visual field abnormality Absence of other known explanations for progressive glaucomatous optic nerve change 15

16 *Rise in IOP Conjunctival redness Corneal edema or cloudiness A shallow anterior chamber A mid-dilated pupil that reacts poorly to light 16

17 *Glaucoma diagnosed by presence of progressive optic neuropathy in 1 or both eyes characterized by acquired typical structural damage to optic nerve associated visual dysfunction 17

18 檢測項目眼壓測量前房隅角檢查杯盤比視野檢查角膜厚度視力檢查 18

19 *Intraocular pressure (IOP) measurement 眼壓測量氣動式眼壓計哥德曼式眼壓計 (Goldmann applanation tonometry) 需接觸眼睛 19

20 氣動式眼壓計檢查數據 20

21 *Visual field evaluation 視野檢查 21

22 *Gonioscopy 前房隅角鏡檢 The use of a goniolens in conjunction with a slit lamp or operating microscope to gain a view of the iridocorneal angle, or the anatomical angle formed between the eye's cornea and iris. diagnosing and monitoring various eye conditions associated with glaucoma. 22

23 *Lowering intraocular pressure (IOP) is the primary goal of therapy. Reduce the risk of glaucomatous progression of visual field loss and/or optic disc changes 23

24 Patient with POAG Diagnosis Estimate initial target intraocular pressure Therapeutic choices for lowering IOP: Medicines Laser trabeculoplasty Incisional glaucoma surgery Cyclodestructive surgery Other glaucoma surgeries 24

25 no Target IOP achieved? Progression of damage? Progression of damage? no yes no yes yes Follow-up Adjust target pressure downward Duration of control of pressure 6months? no yes Adjust target pressure downward. Upward adjustments of target pressure possible if patient stable for a prolonged period and if patient requires or desires less medication Follow-up 25

26 治療選擇 26

27 Agents that suppress aqueous inflow β adrenergic blockers Betaxolol, carteolol, levobunolol, metipranolol, timolol α2 adrenergic agonists Carbonic anhydrase inhibitors Apraclonidine, brimonidine Dorzolamide and brinzolamide(topical), acetazolamide and methazolamide (oral) Agents that increase aqueous outflow Prostaglandin analogues, (prostamide) Bimatoprost, latanoprost, tafluprost, travoprost, unoprostone* α adrenergic agonists Cholinergic agonists Apraclonidine, brimonidine 27 Pilocarpine, carbachol

28 * 為一選擇性 prostanoid FP 受體作用劑, 藉由增加眼房水液流量來降低眼壓 (IOP) 副作用 1. 睫毛變長變多 2. 瞳孔顏色變深 3. 視覺短暫模糊 4. 眼睛癢疼痛較無全身性副作用, 不影響心肺功能 28

29 Xalatan 舒而坦眼藥水 Latanoprost oph.soln 0.005% 2.5ml/bot Lumigan 0.01% 露明目點眼液劑 Bimatoprost 0.01%,3ml/bot 29 用法用量 : 每日一滴於病眼, 建議於夜間投藥

30 * 青光眼第一線用藥 * 非選擇性 :Timolol % 選擇性 :Betaxolol % * 作用機制 : 降低睫狀體上皮的腺體分泌活力, 使房水產生減少 * 副作用 : 暫時性視力模糊眼睛灼熱或刺痛感 * 用法用量 : 每日一次, 一次一滴, 使用前先震搖使用禁忌氣喘患者慢性阻塞性肺病患者心衰竭心因性休克竇性心跳過慢 30

31 Timolast 0.5%, 5.0ml/bot 欲目明點眼液 Timolol maleate 0.5% oph soln 5ml/bot Betoptic 貝特舒眼用懸浮液 Betaxolol hcl oph susp 0.25%,5ml/pc 31

32 * inhibitor of CA-II, the main carbonic anhydrase isoenzyme involved in aqueous humor secretion. Sulfonamide Sensitivity Reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, other blood dyscrasias 32

33 *Dorzolamide 用法用量每次一滴每日三次副作用結膜炎視力模糊口腔感覺異味等 *AcetaZOLAMIDE 250mg/tab -利尿劑 -劑量初劑量250mg 口服一天 1~4次維持劑量依病患狀況而定 -通常與其他藥物併用控制青光眼(e.g.縮瞳劑或散瞳劑) 33

34 Nonselective: improve aqueous outflow Selective: decrease aqueous production, decrease episcleral venous pressure, or increase uveoscleral outflow 44.8% of reported poisonings occurred in children 5 years old drowsiness (40.9%)ataxia (4.5%)pallor (4.5%) irritability (4%)hypotension (4%)bradycardia (4%) miosis (3.4%)respiratory depression (3.4%) 34

35 合併療法 Alpha adrenergic agonis + Beta blockers Prostaglandin analogues + Beta blockers 35

36 *Laser peripheral iridotomy creates a tiny hole in the peripheral iris through which aqueous humor can flow and reach the angle 36

37 *Open-angle glaucoma is an optic neuropathy characterized by progressive peripheral visual field loss followed by central field loss. *The major risk factors for developing open-angle glaucoma include age, black race, family history, and elevated intraocular pressure. 37

38 *Lowering intraocular pressure is the primary goal of therapy. *Choose pharmacologic or laser therapy as first-line treatment rather than surgery. *Beta-blocker is the first line pharmacologic therapy. *Adding a second medication is reasonable if initial monotherapy is not effective. 38

39 *Primary Open-Angle Glaucoma PPP 2010 AAO PPP Glaucoma Panel, Hoskins Center for Quality Eye Care *Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis Deborah S Jacobs, MD *Fiteyes-Understanding Your Test Results * 美國青光眼研究基金會 * 財團法人全民健康基金會 _id=490&itemid=20 39

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont 210 毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼的疗效观察符元党 1, 郑振优 2, 林再雄 2, 周吉良 1. 昌江黎族自治县中西医结合医院, 海南昌江 572700 2. 海南医学院附属医院眼科, 海南海口 570100 1 摘要 : 目的探讨