GLAUCOMA
Glaucoma is an eye disease which is defined as a progressive optical neuropathy or as a disease of the optic nerve. One of the main factors which may lead to glaucoma is high intraocular pressure, although there is no pressure limit above which glaucoma develops; a person with a relatively low pressure may suffer damage to the optic nerve, whereas another who has had high ocular pressure for many years may suffer no damage during his/her lifetime.
It has been demonstrated that several factors may trigger cell apoptosis with loss of the neuronal support structure and later optic nerve function, causing blindness to appear in areas and “pixels” of the field of vision.
These factors include repeated trauma (changes of intraocular pressure), micro-circulation diseases such as Diabetes mellitus, high and low blood pressure, smoking and vasoconstrictor drugs, although it can appear as spontaneous neuronal apoptosis with the probable influence of oncogenes and hereditary factors.
If left untreated, glaucoma can lead to irreversible damage to the optic nerve, with destruction of the same, loss of vision and partial or total blindness.
TREATMENT
Peripheral laser iridotomy is the definitive treatment for acute glaucoma. If the cornea is not transparent or the eye is excessively inflamed, iridotomy should be postponed; otherwise, it should be carried out as soon as possible. As the other eye has an 80% probability of suffering an acute glaucoma attack, preventive iridotomy should be carried out in that eye.
The definitive treatment in patients with intermittent angle-closure, sub-acute or chronic glaucoma is also peripheral laser iridotomy.
Moreover, a peripheral iridotomy using gonioscopy should be carried out on patients in whom a potentially occludable angle is detected, even in the absence of symptoms, in order to prevent angle-closure glaucoma.
The risk of complications in peripheral laser iridotomy is extremely low in comparison with its beneficial effects.
Diplopia, which may be bothersome, may appear if the iridotomy is not carried out in a sufficiently peripheral manner for it to be covered by the upper eyelid.
Bleeding may occur, although this is generally self-contained and inconsequential.
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