terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

3.5.4 - CYCLOPHOTOCOAGULATION Indications When filtration surgery is likely to fail, has failed, or is not feasible. As an alternative to drainage devices. Trans scleral 90 • Nd:YAG (1064 nm) Divided into contact and non-contact, as well as continuous wave and pulsed laser systems Non-contact: the laser energy is transmitted through air from a slit lamp delivery system Contact: transmission directly from the delivery system to the ocular surface via a fiberoptic hand-held probe placed on the conjunctiva Pulsed: transmits energy at relatively short, predetermined time intervals Continuous: allows longer sustained energy delivery with time intervals selected by the surgeon Technique: Peribulbar or retrobulbar injection of a 50:50 mixture of 2% lidocaine and 0.75% bupivicaine with hyaluronidase Shields’ trans-scleral lens Distance from limbus 1-3 mm (ciliary body should be localized with transillumination) Applications: 8-25 over 180°, energy 1.5-10J per pulse • Diode (810 nm) Technique: Peribulbar or retrobulbar injection of a 50:50 mixture of 2% lidocaine and 0.75% bupivicaine with hyaluronidase Distance from limbus 0.5-2.0 mm (ciliary body should be localized with transillumination) Applications: 10-20 over 180°, energy 5-6J per pulse, total treatment per session up to 270° of circumference (avoid 3 and 9 o`clock positions) Endoscopic Endoscopic techniques combined with laser technology allow the photocoagulation of ciliary processes not readily visible via the transpupillary route. The approach can be limbal or via the pars plana, using a fiberoptic probe - Argon laser - Diode laser Transpupillary This procedure is possible only in cases of aniridia, through a large surgical iridectomy or when broad peripheral anterior synechiae cause anterior displacement of the iris. - Argon laser - Diode laser Complications Persistent inflammation Loss of BCVA Phthisis Post-operative management Consider analgesia, topical steroids and topical atropine Ch. 3 - 32 EGS
3.6 - INCISIONAL SURGERY GENERAL PRINCIPLES The different techniques of incisional surgeries have different indications depending on the type of glaucoma. Angle closure glaucoma is usually treated by laser iridotomy or peripheral iridectomy. Different surgical techniques can be used depending on: 1. the target IOP chosen for the individual situation 2. the previous history (surgery, medications) 3. the risk profile (i.e. single eye) 4. the preferences of the surgeon Congenital glaucoma is suited for primary surgery, usually trabeculotomy or goniotomy, or combinations with filtration surgery including antifibrotic agents. For repeated surgery, cyclodestructive and tube implants are used See FC XII TECHNIQUES Since glaucoma surgery is practiced in different ways by different ophthalmologists, a detailed description of surgical techniques is not within the scope of this text. For practical treatment of glaucoma it is permitted to use additional medications if the target IOP is not reached by surgery alone. For the scientific evaluation of a surgical method however, success rate in terms of IOP lowering can only be evaluated in the absence of adjunctive medical treatment. The number of preoperative versus postoperative medications may also depend on the variable compliance of the individual patient before and after surgery. For scientific evaluation of a surgical method, it is useful to count the number of “successes” below a defined cut-off line for IOP as in Fig. 3.3 or calculated according to the CIGTS formula 98 or similar methods. 3.6.1 - PENETRATING GLAUCOMA SURGERY 3.6.1.1 - Trabeculectomy The current operation of choice in POAG is the trabeculectomy, which produces a ‘guarded’ fistula between the anterior chamber and the subconjunctival space 92 . The introduction of improved operating microscopes, instruments and suture materials, has led to numerous modifications and refinements of the original operation. Modifications include the size, shape and thickness of the scleral flap, limbal or fornix based conjunctival flaps, fixed, releasable or adjustable sutures and the use of antimetabolites and other antiscarring agents to reduce scarring. In the hand of experts the success rate of filtering surgery (alone, or with adjunctive medical therapy) in a previously unoperated eye is reported up to 90% at 2 years; there are large differences however in the criteria used for the definition of success 100-109 . Long-term IOP control is achieved in many cases, although some patients do require further therapy or repeat surgery. Non penetrating forms of filtration surgery are also practiced although the majority of randomised controlled trials suggest that the pressure lowering is not as great as trabeculectomy. INDICATIONS 1. In cases where other forms of therapy (namely medicine or laser) have failed. 2. In cases where other forms of therapy are not suitable (eg. where compliance or side-effects are a problem) or appropriate medical treatment is not available. 3. In cases where a target pressure is required that cannot be reached with drops and/or laser. 4. In cases which have such a high IOP at presentation that other forms of treatment are unlikely to be successful 95 . Ch. 3 - 33 EGS
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ISBN: 88-87434-13-1 Editrice DOGMA
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ACKNOWLEDGEMENT This work was made
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2.2.5 - Primary Open-Angle Glaucoma
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Foreword These Definitions and Guid
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INTRODUCTION The aim of the book is
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Since resources are limited worldwi
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II - RANDOMIZED CONTROLLED TRIALS F
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II.3 - COLLABORATIVE NORMAL TENSION
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No stratification for stage of dise
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II. 6. 3 - from CNTG 1. Therapy tha
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References 1) The Ocular Hypertensi
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I - QUESTIONS TO ASK TO YOUR GLAUCO
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III - ABNORMAL THRESHOLD VISUAL FIE
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V - GONIOSCOPIC OPEN ANGLES SOME DI
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VII - TREATMENT STEPLADDER JUVENILE
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IX - MONOTHERAPY (in alphabetic ord
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XI - MANAGEMENT ACUTE ANGLE CLOSURE
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XIII - ANTIMETABOLITES FOR WOUND MO
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CHAPTER 1 PATIENT EXAMINATION
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Other methods 22-25 : Air-puff tono
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References 1) Martin XD. Normal int
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1.2 - GONIOSCOPY Gonioscopy is a fu
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1 2 3 4 Fig. 1 Dynamic indentation
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The Spaeth classification Insertion
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References 1) Palmberg P. Gonioscop
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small - size mid - size large - siz
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Fig. 5 A) Cirumlinear vessel, B) Ba
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1.3.4.3 - OCT The Optical Coherence
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31) Carpineto P, Ciancaglini M, Zup
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central 24 or 30 central degrees re
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A retinal sensitivity value worse t
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HODAPP CLASSIFICATION 31 EARLY GLAU
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References 1) Bengtsson B, Heijl A,
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1.5 - BLOOD FLOW 1.5.1 - VASCULAR F
Page 70 and 71: 28) Flammer J, Orgul S, Costa VP, O
Page 72 and 73: All forms of glaucoma should be cla
Page 74 and 75: 2.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
Page 76 and 77: 2.2.4 - PRIMARY OPEN-ANGLE GLAUCOMA
Page 78 and 79: 2.3 - SECONDARY OPEN-ANGLE GLAUCOMA
Page 80 and 81: 2.3.1.6 - Glaucoma due to intraocul
Page 82 and 83: 2.4 - PRIMARY ANGLE-CLOSURE Primary
Page 84 and 85: Systemic Risk factors for primary a
Page 86 and 87: OCCLUDABLE ANGLE: “Occludable”
Page 88 and 89: 2.5.3 - SECONDARY ANGLE-CLOSURE GLA
Page 90 and 91: CHAPTER 3 TREATMENT PRINCIPLES and
Page 92 and 93: Furthermore, blindness may occur de
Page 94 and 95: T A R G E T I O P Target IOP range
Page 96 and 97: Practical points for topical medica
Page 98 and 99: 3.3.1.1 - Category: ADRENERGIC AGON
Page 100 and 101: 3.3.1.2 - Category: ADRENERGIC ANTA
Page 102 and 103: 3.3.1.3 - Category: CARBONIC ANHYDR
Page 104 and 105: 3.3.1.4 - Category: PARASYMPATHOMIM
Page 106 and 107: 3.3.1.5 - Category: PROSTAGLANDIN D
Page 108 and 109: Drug interactions Precipitation occ
Page 110 and 111: COMBINATION THERAPY Starting* Addit
Page 112 and 113: 3.3.2.2 - Category: ADRENERGIC ANTA
Page 114 and 115: Pregnancy and nursing mothers Only
Page 116 and 117: 3.5 - LASER SURGERY 3.5.1 - LASER I
Page 118 and 119: 3.5.2 - LASER TRABECULOPLASTY 77-89
Page 122 and 123: Although medical therapy is still t
Page 124 and 125: 3.6.4 - COMPLEX CASES Complicated g
Page 126 and 127: Post-operative use Concentration: 0
Page 128 and 129: 25) Janz NK, Wren PA, Lichter PR, M
Page 130 and 131: (Rescula TM ) in patients with glau
Page 132 and 133: in white patients with open-angle g
Page 134 and 135: CHAPTER 4 TREATMENT GUIDELINES
Page 136 and 137: 4.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
Page 138 and 139: 4.2.7 - OCULAR HYPERTENSION (OH) Al
Page 140 and 141: 4.3.1.7 - Glaucoma associated with
Page 142 and 143: • Withdrawal of aqueous from vitr
Page 144 and 145: 4.5 - SECONDARY ANGLE-CLOSURE GLAUC
Page 146 and 147: 4.5.3 - SECONDARY ANGLE-CLOSURE GLA
Page 148 and 149: NOTES
Page 150 and 151: NOTES
Page 152: NOTES
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