Glokom Acilleri
Özet
Glokom, retina ganglion hücrelerinin kaybıyla karakterize, yüksek göz içi basıncının (GİB) en önemli risk faktörü olduğu ilerleyici bir optik nöropatidir. Glokom acilleri, kalıcı görme kaybını önlemek adına acil ve doğru müdahale gerektiren, açının açık veya kapalı olmasına göre sınıflandırılan durumlardır. Hümör aköz sıvısının üretimi ve trabeküler ile uveaskleral yollarla drenajı arasındaki denge GİB'i belirler. Açı muayenesinde altın standart gonyoskopi iken, van Herick ve oblik fener testi gibi klinik yöntemler de ön kamara derinliğini tahmin etmede kullanılır. Görme kayıplarında büyük payı olan primer açı kapanması, genellikle %75 oranında pupiller blok mekanizmasıyla tetiklenir ve ani GİB yükselmesi, sığ ön kamara, ağrı ve korneal ödem ile kendini gösterir. Tedavisinde GİB'i düşüren medikal ajanlar ve lazer iridotomiden yararlanılır. Sekonder açı kapanması ise pupiller blok, öne çekme (neovasküler glokom, iridokorneal endotelyal sendrom) veya arkadan itme (malign glokom) mekanizmalarıyla gelişebilir. Sekonder açık açılı glokomlarda ise gonyoskopide açı açık olmasına rağmen aköz akışı pigmenter glokom (melanin granülleri), psödoeksfoliyasyon glokomu (fibrillo-granüler protein), lens kaynaklı nedenler veya göz içi kanamalar gibi patolojilerle mekanik olarak engellenir.
Glaucoma is a progressive optic neuropathy characterized by the loss of retinal ganglion cells, with high intraocular pressure (IOP) being the most significant risk factor. Glaucoma emergencies are conditions categorized by whether the angle is open or closed, requiring immediate and accurate intervention to prevent permanent vision loss. The balance between aqueous humor production and its drainage through trabecular and uveoscleral pathways determines the IOP. While gonioscopy is the gold standard for angle assessment, clinical methods such as the van Herick technique and the oblique flashlight test are also utilized to estimate anterior chamber depth. Primary angle closure, which accounts for a substantial portion of vision loss, is typically triggered by a pupillary block mechanism in 75% of cases and presents with sudden IOP spikes, a shallow anterior chamber, pain, and corneal edema. Its management relies on IOP-lowering medical agents and laser iridotomy. Secondary angle closure can develop via pupillary block, anterior pulling mechanisms (neovascular glaucoma, iridocorneal endothelial syndrome), or posterior pushing mechanisms (malignant glaucoma). Conversely, in secondary open-angle glaucomas, even though the angle appears open during gonioscopy, aqueous outflow is mechanically obstructed by pathologies such as pigmentary glaucoma (melanin granules), pseudoexfoliation glaucoma (fibrillo-granular protein), lens-induced causes, or intraocular hemorrhages.
Referanslar
Allison K, Patel D, Alabi O. Epidemiology of Glaucoma: The Past, Present, and Predictions for the Future. Cureus. 2020;12(11) DOI: 10.7759/cureus.11686.
Matlach J, Bender S, König J, Binder H, Pfeiffer N, Hoffmann EM. Investigation of intraocular pressure fluctuation as a risk factor of glaucoma progression. Clin Ophthalmol. 2019;13:9-16 DOI: 10.2147/opth.S186526.
Collignon NJ. Emergencies in glaucoma: a review. Bull Soc Belge Ophtalmol. 2005(296):71-81
Murray D. Emergency management: angle-closure glaucoma. Community Eye Health. 2018;31(103):64
King A, Azuara-Blanco A, Tuulonen A. Glaucoma. BMJ : British Medical Journal. 2013;346:f3518 DOI: 10.1136/bmj.f3518.
Goel M, Picciani RG, Lee RK, Bhattacharya SK. Aqueous humor dynamics: a review. Open Ophthalmol J. 2010;4:52-9 DOI: 10.2174/1874364101004010052.
Malihi M, Sit AJ. Aqueous humor dynamics and implications for clinical practice. Int Ophthalmol Clin. 2011;51(3):119-39 DOI: 10.1097/IIO.0b013e31821e5cea.
Johnson M, McLaren JW, Overby DR. Unconventional aqueous humor outflow: A review. Exp Eye Res. 2017;158:94-111 DOI: 10.1016/j.exer.2016.01.017.
Rigi M, Bell NP, Lee DA, Baker LA, Chuang AZ, Nguyen D, et al. Agreement between Gonioscopic Examination and Swept Source Fourier Domain Anterior Segment Optical Coherence Tomography Imaging. J Ophthalmol. 2016;2016:1727039 DOI: 10.1155/2016/1727039.
Unterlauft JD. [Gonioscopy - How, Why, What for?]. Klin Monbl Augenheilkd. 2017;234(8):996-1002 DOI: 10.1055/s-0042-120280.
Kashiwagi K, Tokunaga T, Iwase A, Yamamoto T, Tsukahara S. Agreement between peripheral anterior chamber depth evaluation using the van Herick technique and angle width evaluation using the Shaffer system in Japanese. Jpn J Ophthalmol. 2005;49(2):134-6 DOI: 10.1007/s10384-004-0169-5.
Choudhari NS, Chanda S, Khanna R, Senthil S, Garudadri CS. Diagnostic Accuracy of Van Herick Technique to Detect Pre-Disease States of Primary Angle Closure Glaucoma in a Resource Constraint Region. Ophthalmic Epidemiol. 2019;26(3):175-82 DOI: 10.1080/09286586.2018.1562083.
Shikino K, Hirose Y, Ikusaka M. Oblique Flashlight Test: Lighting Up Acute Angle-Closure Glaucoma. J Gen Intern Med. 2016;31(12):1538 DOI: 10.1007/s11606-016-3737-8.
He M, Huang W, Friedman DS, Wu C, Zheng Y, Foster PJ. Slit lamp-simulated oblique flashlight test in the detection of narrow angles in Chinese eyes: the Liwan eye study. Invest Ophthalmol Vis Sci. 2007;48(12):5459-63 DOI: 10.1167/iovs.07-0670.
Alward WL. A history of gonioscopy. Optom Vis Sci. 2011;88(1):29-35 DOI: 10.1097/OPX.0b013e3181fc3718.
Wright C, Tawfik MA, Waisbourd M, Katz LJ. Primary angle-closure glaucoma: an update. Acta Ophthalmol. 2016;94(3):217-25 DOI: 10.1111/aos.12784.
Atalay E, Nongpiur ME, Baskaran M, Sharma S, Perera SA, Aung T. Biometric Factors Associated With Acute Primary Angle Closure: Comparison of the Affected and Fellow Eye. Invest Ophthalmol Vis Sci. 2016;57(13):5320-5 DOI: 10.1167/iovs.16-20006.
Emanuel ME, Parrish RK, 2nd, Gedde SJ. Evidence-based management of primary angle closure glaucoma. Curr Opin Ophthalmol. 2014;25(2):89-92 DOI: 10.1097/icu.0000000000000028.
Sun X, Dai Y, Chen Y, Yu DY, Cringle SJ, Chen J, et al. Primary angle closure glaucoma: What we know and what we don't know. Prog Retin Eye Res. 2017;57:26-45 DOI: 10.1016/j.preteyeres.2016.12.003.
RPL W, E J. - Glaucoma: acute and chronic primary angle-closure. - BMJ Clin Evid 2015 Dec 8;2015:0703 eCollection 2015. (- 1752-8526 (Electronic)):T - epublish
Nüßle S, Lübke J. [Secondary Angle Closure Glaucoma]. Klin Monbl Augenheilkd. 2021;238(11):1251-62 DOI: 10.1055/a-1545-9983.
Parivadhini A, Lingam V. Management of Secondary Angle Closure Glaucoma. J Curr Glaucoma Pract. 2014;8(1):25-32 DOI: 10.5005/jp-journals-10008-1157.
Havens SJ, Gulati V. Neovascular Glaucoma. Dev Ophthalmol. 2016;55:196-204 DOI: 10.1159/000431196.
Sacchetti M, Mantelli F, Marenco M, Macchi I, Ambrosio O, Rama P. Diagnosis and management of iridocorneal endothelial syndrome. BioMed research international. 2015;2015
Bansal S, Gunasekeran DV, Ang B, Lee J, Khandelwal R, Sullivan P, et al. Controversies in the pathophysiology and management of hyphema. Surv Ophthalmol. 2016;61(3):297-308 DOI: 10.1016/j.survophthal.2015.11.005.
Bai HQ, Yao L, Wang DB, Jin R, Wang YX. Causes and treatments of traumatic secondary glaucoma. Eur J Ophthalmol. 2009;19(2):201-6 DOI: 10.1177/112067210901900205.
Kalogeropoulos D, Sung VC. Pathogenesis of Uveitic Glaucoma. J Curr Glaucoma Pract. 2018;12(3):125-38 DOI: 10.5005/jp-journals-10028-1257.
De Leon-Ortega JE, Girkin CA. Ocular trauma-related glaucoma. Ophthalmol Clin North Am. 2002;15(2):215-23 DOI: 10.1016/s0896-1549(02)00011-1.
Razeghinejad R, Lin MM, Lee D, Katz LJ, Myers JS. Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol. 2020;65(5):530-47 DOI: 10.1016/j.survophthal.2020.02.003.
Fekih O, Zgolli HM, Mabrouk S, Abdejelil A, Zeghal I, Nacef L. Malignant glaucoma management: literature review. Tunis Med. 2019;97(8-9):945-9
Scuderi G, Contestabile MT, Scuderi L, Librando A, Fenicia V, Rahimi S. Pigment dispersion syndrome and pigmentary glaucoma: a review and update. Int Ophthalmol. 2019;39(7):1651-62 DOI: 10.1007/s10792-018-0938-7.
Qing G, Wang N, Tang X, Zhang S, Chen H. Clinical characteristics of pigment dispersion syndrome in Chinese patients. Eye. 2009;23(8):1641-6 DOI: 10.1038/eye.2008.328.
Pasutto F, Zenkel M, Hoja U, Berner D, Uebe S, Ferrazzi F, et al. Pseudoexfoliation syndrome-associated genetic variants affect transcription factor binding and alternative splicing of LOXL1. Nature Communications. 2017;8(1):15466 DOI: 10.1038/ncomms15466.
Plateroti P, Plateroti AM, Abdolrahimzadeh S, Scuderi G. Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management. Journal of Ophthalmology. 2015;2015 DOI: 10.1155/2015/370371.
Drolsum L, Ringvold A, Nicolaissen B. Cataract and glaucoma surgery in pseudoexfoliation syndrome: a review. Acta Ophthalmol Scand. 2007;85(8):810-21 DOI: 10.1111/j.1600-0420.2007.00903.x.
Papaconstantinou D, Georgalas I, Kourtis N, Krassas A, Diagourtas A, Koutsandrea C, et al. Lens-induced glaucoma in the elderly. Clin Interv Aging. 2009;4:331-6 DOI: 10.2147/cia.s6485.
Etheridge T, Larson JC, Nork TM, Momont AC. Schwartz-Matsuo syndrome: An important cause of secondary glaucoma. Am J Ophthalmol Case Rep. 2020;17:100586 DOI: 10.1016/j.ajoc.2020.100586.
Fea A, Bertaina L, Consolandi G, Damato D, Lorenzi U, Grignolo F. Angle Closure Glaucoma: Pathogenesis and Evaluation. A Review J Clinic Experiment Ophthalmol. 2012;4(005):1-7
Riva I, Micheletti E, Oddone F, Bruttini C, Montescani S, De Angelis G, et al. Anterior Chamber Angle Assessment Techniques: A Review. J Clin Med. 2020;9(12) DOI: 10.3390/jcm9123814.
