NHMRC Glaucoma Guidelines - ANZGIG

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NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 10 – Laser therapy and surgery ■ Chapter 10 Laser therapy and surgery Recommendation 12 Reduce IOP by using laser techniques and incisional surgery. Good Practice Points • Offer laser trabeculoplasty as an alternative, or additive to medications. • Offer surgical IOP reduction when medications and/or laser trabeculoplasty fail to meet targets or are unsuitable, and visual disability is threatened. There are inherent risks with invasive procedures, which must be justified by likely benefits. • Glaucoma drainage devices may control IOP long-term and may be suitable if other drainage surgery fails, or as first-line surgery in eyes with higher risks of failure (including inflammatory glaucomas and ICE syndrome). Recommendation 13 If indicated, perform prophylactic laser peripheral iridotomy in both eyes to prevent progressive anterior segment damage. Good Practice Point • Peripheral iridoplasty might be useful after iridotomy in individual cases. Consider cataract extraction and ongoing IOP control, including trabeculectomy as required. Recommendation 14 Ensure patients are aware of risks and symptoms of angle-closure and can access care urgently as necessary. Introduction All clinical guidelines highlight the importance of choosing the most appropriate management approach on a case-by-case basis. Traditionally, glaucoma treatment has begun with medications, proceeding to laser therapy and surgery when necessary. This approach was designed to maximise the benefit of treatment while minimising risk to the patient. When making the choice of a specific form of treatment or the decision to alter or provide additional treatment, the overriding consideration must be to minimise the risks and maximise the benefit to the patient. All forms of treatment for glaucoma have potential side effects or complications, and the possible impact of the treatment, must be evaluated from a social, psychological, financial, and convenience standpoint. National Health and Medical Research Council 139
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 10 – Laser therapy and surgery The available non-medication interventions are broadly grouped into laser techniques, incisional and implant surgery. The primary purpose of laser therapy and surgery is to make a selective lesion in one or more structures of the eye to reduce the intraocular pressure (IOP). The outcomes of these interventions focus on the ability to achieve and maintain a lowered IOP, retention of an open angle with functional trabecular meshwork, reduction of anti-glaucoma medication usage, improvement of visual acuity and minimisation of visual field (VF) loss. Other outcomes include the reduced need for additional surgery and minimisation of adverse/harmful effects. Figure 10.1 illustrates the anatomy of the glaucomatous eye as a guide to the terminology reported for the interventions described in this chapter. Figure 10.2 illustrates the two main types of glaucoma (open angle and angle closure). Figure 10.1: The anatomy of the eye (Source: Members of the NHMRC Working Committee) Posterior Chamber Ciliary Body Cornea Anterior Chamber Trabecular Meshin Angle Sclera Lens Zonules Figure 10.2 : An illustration of open angle and angle closure glaucoma with trabecular meshwork (Source: www.angleclosureglaucoma.cn) closed angle trabecular meshwork Cornea open angle Cornea trabecular meshwork Ciliary body Lens Lens Ciliary body 140 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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