Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

630 Glaucoma Glomerular Diseases

■Outpatient surgeries

■Extremely effective for many glaucomas

■Risk is higher than with medication or laser

■As close to a cure possible, over 90% effective, 50% for 10 years or

longer

■Useful in severe glaucomas or progressive glaucomas despite medi-

cal therapy

■Tube-shunts are useful in eyes likely to scar or those that have failed

multiple trabeculectomies

follow-up

■Medically treated stable eyes

■IOP check every 3–6 months

■Visual field annually

■Stereo disc photos every 2–4 years

complications and prognosis

■Depends on initial disease severity and age at presentation

■Earlier, severe disease most risky

■Careful follow-up and treatment to lower pressure dramatically

■2–3% of glaucoma patients become blind

■5 times greater blindness in African-Americans

Glomerular Diseases..................................

GERALD B. APPEL, MD, FACP

history & physical

■Swelling of extremities and especially around the eyes in AM, weight

gain, foamy or bubbly urine, decreased urine output, fatigue, weak-

ness.

■History of systemic condition associated with glomerulonephritis

(diabetes, lupus, amyloidosis), use of medications (e.g. NSAIDs,

lithium, gold salts), hx of infections (Hep C, Hep B, streptococcal,

HIV), family history (Alport’s).

■Ankle and leg edema, periorbital edema in the A.M., if excessive

systemic fluid retention anasarca, ascites, pleural effusions.

tests

■Blood:BUN/ creatinine, serum albumin, serum cholesterol. FBS and

HgBA1C.