MANUAL DE GONIOSCOPIA. La exploracion clinica del angulo irido- corneal ( Manual of Gonioscopy. Clini cal examination of the irido-corneal angle). By Angel . A gonioscopia direta é usualmente realizada com a lente de Koeppe e pratica- Figura 5 - A gonioscopia de indentação permite o exame do recesso do seio. PDF | Purpose: To assess Automatic Gonio-Photography (AGP)-true color images of the anterior gonioscopia circa l'identificazione di reperti.
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Angulo cerrado en gonioscopia sin estructuras visibles. Angulo abierto en gonioscopia terney.info An evaluation of the anterior chamber angle's configura- tion is an essential part of the anterior segment ex- amination, especially in patients with glaucoma. In addition to this downloadable pdf of the book, the links to each individual chapter and the videos that were previously available on DVD and.
Case 4 A 21 year-old Caucasian son was examined. Case 5 A 19 year-old Caucasian daughter was examined and considered asymptomatic.
Slit lamp evaluation disclosed bilateral nasal and temporal posterior embryotoxon and sectorial iris atrophy with mild corectopy. No polycoria or systemic signs was observed. The intraocular pressure applanation tonometry was 13 mmHg in the right eye and 12 mmHg in the left eye. Specular microscopic examination was normal as well as the rest of the ocular examination.
Interestingly, Hwang et al.
There are two genes encoding transcription factors and three loci that are associated with the Axenfeld-Rieger malformation. The gene PITX2 "pituitary homeobox transcription factor 2", RIEG1 was cloned on chromosome 4p25 and regulates the expression of other genes during embryonic development Several pathological mutations deletions, translocations or spot mutations in PITX2 have been described causing different phenotypes, including AR malformation11, iridogoniodysgenesis 12, iris hypoplasia13 and rarely Peters' anomaly During the embryogenesis, FOXC1 is expressed in craniofacial structures, in periocular and pre-endothelial mesenchyma, sclera and cornea and further, in the pos-fetal phase, in trabecular meshwork, iris and conjuntival epithelium.
The mutations include duplications, insertions, deletions and missense types affecting the DNA ligation stability, activation of specific genes and transcriptional regulation. These mutations produce a very large spectrum of phenotypes of anterior segment dysgenesis, mild to severe form, including or not systemic manifestations.
In the Fuchs dystrophy, the mechanism of progressive dysfunction of corneal endothelium and the collagen deposition remains unknown, and it is not clear whether it is a primary or secondary effect.
Several theories have been proposed to explain the etiology of FECD. Biswas et al. There are studies suggesting that apoptosis plays an important role in endothelial cell degeneration7. It is possible that a modification of the basement membrane composition Descemet membrane or the loss of contact between endothelial cell and Descemet membrane may cause apoptosis of these cells in Fuchs' Dystrophy.
Further studies are needed to investigate this hypothesis. The mechanism of the ocular bad development has been widely studied and discussed Often the factors that result in disturbance of neural crest may act at more than one phase of this process, producing anomalies that involve more than one tissue derived from neural crest. This case series was the first description of this combination of two ocular abnormalities together Fuchs dystrophy and Axenfeld-Rieger anomaly and was reported on world ophthalmology congress in Later on, Kniestedt et al.
Perhaps, in future, it would be possible to develop alternative therapeutic tools for the treatment of Fuchs dystrophy and glaucoma, based on the knowledge of their etiology. A molecular basis for differential developmental anomalies in Axenfeld-Rieger syndrome.
Hum Mol Genet. Anterior segment dysgenesis and the developmental glaucomas are complex traits. Alward WL. The specific pathologies.
This can then initiate an efficient study was approved by the ethics committee of the L V referral process to confirm the diagnosis and adminis- Prasad Eye Institute and was conducted according to the ter the appropriate treatment within a reasonable time tenets of the Declaration of Helsinki.
Informed consent was frame. It also helps developing the communication with obtained from all the participants. During this time between and glaucoma shared care of glaucoma patients.
Both the optometrists performed gonioscopy and optic enables a coordinated training and development model disc assessment on over patients while gaining expe- for all professionals involved in glaucoma detection and rience in the assessment and management of patients with management. It has been shown in various the standard proforma of patient examination.
The L V Prasad Eye Institute, being a centre of excellence The primary goal of this study is to establish the in the eye care delivery pyramidal model,15 most of the sensitivity and specificity with which the two experi- patients come with complex eye problems. Patients initially enced optometrists can detect glaucomatous changes using report to the front office personnel and are directed to the gonioscopy and optic disc assessment relative to the gold comprehensive outpatient department where the complete standard ophthalmologists diagnosis.
Referral to the subspecialty clinic is then made is advocated by the World Health Organization WHO , at depending on the necessity. The examination procedures the lowest level of the pyramid is a vision center managed were based on the standard proforma.
For each patient, by a vision technician. Primarysecondary interface exists post dilation evaluation of the optic disc and fundus was between the primary care services at the vision center and done with a Each vision Disc cupping and appearance were documented by drawing center caters to a population of 50, Agreement of glaucoma specialists and experienced optometrists in gonioscopy and optic disc evaluation rim, asymmetry, peripapillary atrophy, disc haemorrhages were estimated, assigning linear weights to disagreements and collateral vessels.
Gonioscopy was carried out for every among the above categories. Details of the kappa statis- patient before dilation, with a Sussman 4 mirror gonio tic have been explained elsewhere. For the current study all examiners retained their likelihood ratios.
For this analysis, the suspect categories own gonioscopic and optic disc assessment information so in both gonioscopy and optic disc interpretation were com- that the entire procedure remained masked among the bined with the disease category for both optometrists and observers.
No other clinical data were available to ophthalmologists. Likelihood ratio LR is the probability the observers. The LR for a given test result indicates Categorization of gonioscopy and optic disc findings how much that result will raise or lower the probabil- ity of disease. A LR of 1, or close to 1, would mean For the purpose of the current study gonioscopic findings that the test provides no additional information about the were categorized as 0, 1 and 2 for open angle, primary post-test probability of the disease.
For effects. A classification was used. After Separate cohorts of subjects were evaluated for agree- the initial work-up by the general optometrists, each of the ment in gonioscopy and optic disc interpretation by both two experienced optometrists and the glaucoma specialist optometrists.
Optometrist 1 performed gonioscopy in 72 ophthalmologist carried out gonioscopy. Mean age of these subjects was angles without any other abnormality.
Statistical analysis Tables 3 and 4 show the diagnostic accuracies of each optometrist separately for gonioscopy and optic disc The primary outcome was the agreement between glau- evaluation. Three possible diagnostic categorizations were open from occludable angles. Positive and negative likeli- considered both for gonioscopy and optic disc evaluation. Table 1 Agreement between glaucoma specialists and optometrists in interpretation of gonioscopy.
Table 2 Agreement between glaucoma specialists and optometrists in interpretation of optic disc. How- ever, our main purpose is to compare the glaucoma trained Discussion optometrists and glaucoma specialist ophthalmologist, such that the results can be used to validate the use of the same Our results show that there is a high level of agreement glaucoma trained optometrists in the LVPEI-GLEAMS. As visual acuity assessment alone misses most cases of glaucoma and screening field tests can be ineffective, 21 the need for a Table 3 Diagnostic accuracies of optometrists in interpre- more complete evaluation of each individual is evident.
The observers in that study Specificity Again however varying levels of experience existed among the various observers23,24 Table 4 Diagnostic accuracies of optometrists in interpre- and when clinical documentation of the optics discs through tation of optic disc. Specificity While many physicians perform visual field tests and declaration-to-boost-indian-optometry.
Targeting rela- by gonioscopy. J Glaucoma.
Darren Shickle D, Hogg R. What is ophthalmic public health?. The uniqueness of the current study lies in the involve- Academy for Eye Care Excellence. The regard.
Oph- One limitation of the current study was that for logisti- thalmic Physiol Opt. The Peterborough scheme the three glaucoma specialists. The assumption that there for community specialist optometrists in glaucoma: a feasibil- ity study. Eye Lond. In conclusion, our results show that there is a high level A national survey of diagnostic tests reported by UK of agreement between glaucoma specialists and trained community optometrists for the detection of chronic optometrists in gonioscopy and optic disc assessment.
We open angle glaucoma. Ophthalmic Physiol Opt. The accuracy of accredited glaucoma optometrists in the thalmologists.
This suggests that the optometrist with good diagnosis and treatment recommendation for glaucoma. Br J experience and clinical skills, if trained in optic disc assess- Ophthalmol. This adds to and reinforces previous Garway-Heath D. Agreement between optometrists and work demonstrating similar results based on the assessment ophthalmologists on clinical management decisions for of the optic disc.