NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 10 – Laser therapy and surgery
Table 10.1: Summary of indicators for surgical/laser treatments
Surgery Source Contraindication
Argon laser AOA (2002) Uveitic glaucoma
trabeculoplasty RCO (2004) Young patients,
especially children
Narrow or
closed angles
Indications
for use Benefits Drawbacks
Reduces IOP
in MOST eyes
by an average
of 30%
Effect diminishes
over time.
May increase the
chance of future
surgical failure.
Nd:YAG laser
iridotomy
RCO(2004) Caution required –
watch for post-laser
IOP rise in those with
marked synechial
angle closure
In the absence
of symptoms
of intermittent
angle closure
Only effective
with narrow but
open drainage
angles and some
iris-trabecular
contact
Cyclodiode
laser
AOA (2002) Some uveitis Where other
modalities
have failed
Incisional
filtration
Surgery
AOA(2002)
Contraindicated in eyes
that are already blind
or patients with severe
systemic illness
In NTG or
POAG resistant
to other forms
of therapy
Dramatic
and stable
reduction
in POAG
Many patients
must remain
on medication
and may require
additional
filtration or
other surgery
Anti-fibrotic
use
AOA (2002)
The elderly or those
with frail conjunctiva
Eye at risk of
later failure due
to scarring of the
drainage bleb
Caution required
especially for
those with
high potency
References
American Academy of Ophthalmology [AAO] (2005a): Primary angle closure preferred practice
pattern. San Francisco: American Academy of Ophthalmology.
American Academy of Ophthalmology [AAO] (2005b): Primary open-angle glaucoma preferred
practice pattern. San Francisco: American Academy of Ophthalmology.
American Academy of Ophthalmology [AAO] (2005c): Primary open-angle glaucoma suspect
preferred practice pattern. San Francisco: American Academy of Ophthalmology.
American Optometric Association [AOA] (2002): Optometric clinical practice guideline: Care of
the patient with open angle glaucoma (2nd edn.). St Louis: American Optometric Association.
Burr J, Azuara-Blanco A, Avenell A (2004): Medical versus surgical interventions for open angle
glaucoma. Cochrane Database of Systematic Reviews; 1.
Doe EA, Budenz DL, Gedde SJ, Imami NR (2001): Long-term surgical outcomes of patients with
glaucoma secondary to the iridocorneal endothelial syndrome. Ophthalmology; 108:1789–1795.
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