Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- razão escavação/disco >0.5
- entalhe da escavação do nervo óptico
- perda da visão periférica sintomática
- aumento da pressão intraocular
- escotomas
- perda da camada de fibra nervosa
- hemorragia do disco óptico
Outros fatores diagnósticos
- histerese da córnea
Fatores de risco
- pressão intraocular >21 mmHg
- idade >50 anos
- histórico familiar de glaucoma
- Anormalidades genéticas
- etnia negra ou etnia hispânica
- miopia
- diabetes mellitus
- hipertensão
- baixa pressão de perfusão ocular
- espessura fina da córnea central
- histerese da córnea
- bloqueadores dos canais de cálcio
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- tonometria
- gonioscopia
- oftalmoscopia direta
- oftalmoscopia indireta
- biomicroscopia com lâmpada de fenda
- teste de campo visual
- varredura por tomografia de coerência óptica
Investigações a serem consideradas
- imagem digital
- paquimetria
- análise da camada de fibra nervosa
Novos exames
- histerese da córnea
Algoritmo de tratamento
colírios preferenciais ou trabeculoplastia a laser contraindicados/falharam
preferência por trabeculoplastia a laser ou colírios contraindicados/falharam
colírios contraindicados/falharam e a doença é rapidamente progressiva
falha do tratamento
Colaboradores
Autores
Nishani Amerasinghe, MBBS, BSc(Hons), FRCOphth
Consultant Ophthalmic Surgeon
Glaucoma Specialist
University Hospital Southampton NHS Trust
Southampton
UK
Declarações
NA is president-elect of the UK and Éire Glaucoma Society and has acted as an unpaid advisor to NICE and The Royal College of Ophthalmologists. NA has served on an advisory panel for Santen and has received travel honoraria and speaker's fees from Thea Pharmaceuticals, Santen, and Allergan. NA has received research funding from AbbVie Pharmaceuticals.
Irena Serov-Volach, MD
Senior Glaucoma and Cataract Fellow
Ophthalmology department
Eye Unit
Epsom and St Helier University Hospitals NHS Trust
London
UK
Declarações
ISV has received consultancy/travel fees from Glaukos.
Agradecimentos
Dr Nishani Amerasinghe and Dr Irena Serov-Volach would like to gratefully acknowledge Dr Robert B. Avery and Dr Michael N. Wiggins, the previous contributors to this topic.
Declarações
RBA and MNW declare that they have no competing interests.
Revisores
Andrew Chen, MD
Assistant Professor
University of Washington
Seattle
WA
Declarações
AC declares that he has received research funding from Janssen LLC.
Sheila Sanders, MD
Professor of Ophthalmology
University of Kentucky
South Limestone
Lexington
KY
利益声明
SS declares that she has no competing interests.
Mohamed Khodeiry, MD
Glaucoma Fellow
University of Kentucky
South Limestone
Lexington
KY
利益声明
MK declares that he has no competing interests.
Roshini Sanders, FRCS, FRCOphth
Consultant Ophthalmologist
Queen Margaret Hospital
Dunfermline
Fife
UK
利益声明
RS declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Weinreb RN, Leung CK, Crowston JG, et al. Primary open-angle glaucoma. Nat Rev Dis Primers. 2016 Sep 22;2:16067. 摘要
International Council of Ophthalmology. ICO guidelines for glaucoma eye care. Feb 2016 [internet publication].全文
American Academy of Ophthalmology. Primary open-angle glaucoma preferred practice pattern. Nov 2020 [internet publication].全文
American Academy of Ophthalmology. Primary open-angle glaucoma suspect preferred practice pattern. Nov 2020 [internet publication].全文
National Institute for Health and Care Excellence. Glaucoma: diagnosis and management. Jan 2022 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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