Steroid response glaucoma icd 10

Douglas J Rhee, MD  Chair and Professor, Department of Ophthalmology and Visual Science, University Hospitals Eye Institute, Case Western Reserve University School of Medicine

Douglas J Rhee, MD is a member of the following medical societies: Alpha Omega Alpha , Association for Research in Vision and Ophthalmology , American Glaucoma Society , American Academy of Ophthalmology , American Medical Association , Phi Beta Kappa

Disclosure: Received grant/research funds from Alcon for independent contractor; Received grant/research funds from Allergan for independent contractor; Received consulting fee from Alcon for consulting; Received consulting fee from Allergan for consulting; Received grant/research funds from Merck for independent contractor; Received grant/research funds from Ivantis for independent contractor; Received consulting fee from Glaukos for consulting; Received consulting fee from Ivantis for consulting; Received.

Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.

Treatment for Steroid Induced Glaucoma

If possible the corticosteroid treatment should be discontinued, and typically the lowering of IOP tends to mirror the initial response of IOP increase, . within one to four weeks, or for rapid onset, it will fade away in a few days. In a very small proportion of patients, usually those with long term steroid use or family history of glaucoma, the IOP will not fall after cessation of steroid use.

Otherwise management of the elevated IOP is similar to the standard treatment for POAG. Eyedrops to lower IOP are effective such as beta-blockers and carbonic anhydrase inhibitors. Prostaglandins are also effective although not recommended for patients who have uveitis or cystoid macular oedema.

In terms of surgery, in some cases a trabeculectomy may be required.

If steroids are still required, the general guideline is for doctors to try and prescribe the weakest dosage for the shortest possible time required to achieve their objectives, and to switch from delivery to the eye to a systemic exposure to the medication.

Before starting any corticosteroid treatment, especially if the patient has any of the risk factors above, a baseline IOP should be measured and the patient assessed for their risk of developing glaucoma. They should then be checked for any increase in IOP by an eye doctor on a regular basis, . every two weeks for the first month and monthly for three months, then every three months thereafter.

The ExPress glaucoma filtration device, a stainless steel nonvalved shunt, is inserted through a conjunctival flap to drain aqueous from the anterior chamber without removal of any scleral or iris tissue. Optinol (Kansas City, KS) introduced the Ex-PRESS mini glaucoma shunt in an attempt to simplify the glaucoma drainage device implantation.  This device is a single-piece, stainless steel, translimbal implant that is placed using an inserter.  Although its ease of implantation is greatly desired, its long-term efficacy and risk of complications have yet to be determined.  The Ex-PRESS mini glaucoma shunt is a 400-micron diameter tube made from implantable stainless steel that is less than 3 mm long, and is loaded on a specially designed disposable inserter.  The device reduces IOP by diverting excess aqueous humor from the anterior chamber to a subconjunctival bleb.  The Ex-PRESS shunt has an advantage over conventional filtering surgery in that it is minimally invasive.  Originally, the Ex-PRESS was designed for a direct limbus insertion through the irido-corneal angle under a conjunctival flap to drain aqueous from the anterior chamber to the subconjunctival space.  However, because of long-term complications, including conjunctival erosions, hypotony, tube dislocation, conjunctival scarring or fibrosis within the tube, the device was re-designed.  The new device is inserted via an external approach in the superficial scleral flap through the trabeculum into the anterior chamber.

Toxic glaucoma is open angle glaucoma with an unexplained significant rise of intraocular pressure following unknown pathogenesis. Intraocular pressure can sometimes reach 80 mmHg (11 kPa). It characteristically manifests as ciliary body inflammation and massive trabecular o edema that sometimes extends to Schlemm's canal . This condition is differentiated from malignant glaucoma by the presence of a deep and clear anterior chamber and a lack of aqueous misdirection. Also, the corneal appearance is not as hazy. A reduction in visual acuity can occur followed neuroretinal breakdown.

Steroid response glaucoma icd 10

steroid response glaucoma icd 10

The ExPress glaucoma filtration device, a stainless steel nonvalved shunt, is inserted through a conjunctival flap to drain aqueous from the anterior chamber without removal of any scleral or iris tissue. Optinol (Kansas City, KS) introduced the Ex-PRESS mini glaucoma shunt in an attempt to simplify the glaucoma drainage device implantation.  This device is a single-piece, stainless steel, translimbal implant that is placed using an inserter.  Although its ease of implantation is greatly desired, its long-term efficacy and risk of complications have yet to be determined.  The Ex-PRESS mini glaucoma shunt is a 400-micron diameter tube made from implantable stainless steel that is less than 3 mm long, and is loaded on a specially designed disposable inserter.  The device reduces IOP by diverting excess aqueous humor from the anterior chamber to a subconjunctival bleb.  The Ex-PRESS shunt has an advantage over conventional filtering surgery in that it is minimally invasive.  Originally, the Ex-PRESS was designed for a direct limbus insertion through the irido-corneal angle under a conjunctival flap to drain aqueous from the anterior chamber to the subconjunctival space.  However, because of long-term complications, including conjunctival erosions, hypotony, tube dislocation, conjunctival scarring or fibrosis within the tube, the device was re-designed.  The new device is inserted via an external approach in the superficial scleral flap through the trabeculum into the anterior chamber.

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