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Ophthalmology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Damage to the optic nerve secondary to raised intraocular pressure. Classified as primary or secondary (associated with ocular disease); acute or chronic; and closed-angle (iris in contact with the trabecular meshwork) or open-angle (iris not in contact with the trabecular meshwork): Chronic (open angle) – asymptomatic until well-advanced but causes progressive visual field defect with cupped optic disc; routine screening necessary for early diagnosis; familial – check relatives. Treatment: with topical eye drops, e.g. latanoprost, β-blockers (e.g. timolol), pilocarpine. Rarely surgery is necessary – trabeculectomy.Acute closed angle – presents with painful, red eye with loss of vision. Pupil may be fixed and dilated. Urgent treatment is required with IV acetazolamide, topical pilocarpine and then laser iridotomy or iridectomy.
Glaucoma drainage implants and vitreoretinal surgery
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Herbert P Fechter III, Richard K Parrish II
The extent of subconjunctival fibrosis may be judged by moving the limbal conjunctiva with a cotton-tipped applicator soaked with proparacaine hydrochloride. A trabeculectomy can be performed if the conjunctiva is freely mobile and there is minimally scarred conjunctiva. Sterile balanced saline solution (BSS, Alcon, Fort Worth, TX) may be injected into the subconjunctival space to determine if firm adhesions between the episclera and subconjunctival tissue limit mobility. If the superior conjunctiva cannot be elevated, the surgeon should consider a glaucoma drainage device rather than an inferiorly placed trabeculectomy, since filtering blebs in this location pose an increased risk of late-onset postoperative endophthalmitis. A lower-quadrant glaucoma drainage device, due to the more posterior location of the thicker drainage bleb, is less likely to develop a leak or infection than a trabeculectomy.4
How to master MCQs
Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
Scheie's procedure creates a full-thickness sclerotomy. Hence, intraocular pressure is less controlled and hypotony is common. Trabeculectomy involves removing part of the sclera to create a sclerotomy which is then covered by a scleral flap. The procedure is performed anterior to the ciliary body. Goniotomy is performed in congenital glaucoma to create a communication between the anterior chamber and Schlemm's canal. It involves incision of the trabecular meshwork at a point between Schwalbe's line and the scleral spur. Trabeculotomy establishes a communication between the anterior chamber and Schlemm's canal by partial removal of the trabecular meshwork (goniotomy ab externo). Trabeculodialysis involves incision of Schwalbe's line followed by disinsertion of the trabecular meshwork from the scleral spur.
Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)Following Acute COVID-19 Infection
Published in Ocular Immunology and Inflammation, 2023
Cigdem Altan, Berna Basarir, Serife Bayraktar, Ilknur Tugal-Tutkun
Increased IOP is present in both syndromes but seems to be more frequent and higher in BAIT than in BADI syndrome.9,15 Dense pigment accumulation in the trabecular meshwork explains an early severely elevated IOP. We also noted a strong initial pigmentation of the trabeculum in all cases. In BAIT, increased IOP occurs earlier and sometimes particularly resistant to treatment that may even require glaucoma surgery.26–28 In our cases, 7 of 24 BAIT eyes (29%) required trabeculectomy. The mean time from onset of symptoms until trabeculectomy was 4.5 months. In the series of Tugal-Tutkun et al., 14 patients (54%) had IOP rise during follow-up, two of them required bilateral trabeculectomy with MMC.9 Bayraktar et al. reported successful results of trabeculectomy with MMC in nine eyes of six patients with BAIT-associated ocular hypertension or glaucoma. The time interval between initial symptoms and trabeculectomy ranged between 42 and 128 days in their study.28 Absence of intraocular inflammation may be an important factor in the long-term successful results of trabeculectomy despite the presence of ongoing pigment dispersion in the aqueous humor.28 In our patients, complete success was obtained in six eyes, and qualified success in one eye.
Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) Differ by Glaucoma Type: IRIS Registry Analysis 2013–2018
Published in Ophthalmic Epidemiology, 2022
Shuang-An Yang, William G Mitchell, Nathan Hall, Tobias Elze, Joan W Miller, Alice C Lorch, Nazlee Zebardast
To understand the patterns of use of both standard and novel glaucoma surgical techniques over the most recent six-year period in the US, cumulative proportions of standard glaucoma surgical interventions (defined as either trabeculectomy or GDD) and of novel surgical techniques (MIGS; defined as either iStent, Cypass, Xen Gel stent, Goniotomy, or Canaloplasty) performed for each of the aforementioned glaucoma diagnoses were studied. Next, analysis of the most frequent concurrent glaucoma surgical interventions for the commonest glaucoma diagnoses over the six-year period was undertaken. Finally, analysis of the most common sequential glaucoma procedures to follow either first (i) trabeculectomy, or (ii) GDD surgical intervention for the most common glaucoma diagnoses was performed.
Effects of Ab Interno XEN Gel Implantation on Postural Intraocular Pressure Elevations
Published in Seminars in Ophthalmology, 2021
Alev Ozcelik Kose, Fehim Esen, Serhat Imamoglu, Nimet Yesim Ercalik, Hatice Tekcan, Suleyman Kugu
The control of IOP is the most important achievable target in glaucoma treatment. The simplest method is glaucoma eye drops, which have been used successfully in many patients.14 Surgical procedures are alternative approaches for reducing IOP. Trabeculectomy is the oldest of the currently preferred surgical procedures, and it remains the gold standard for the surgical management of glaucoma.15 Despite medical advances over the years, the changes in IOP cannot be precisely predicted even after a very successful trabeculectomy. Therefore, this surgery has the potential for complications arising from postoperative ocular hypertension or hypotony. To reduce this unpredictability in surgical outcomes, many new minimally invasive surgical methods and/or tools are being developed and tested.16 The ab interno XEN45 gel stent (Allergan, Dublin, Ireland) is a minimally invasive glaucoma surgery implant for glaucoma treatment. This implant is placed between the anterior chamber and subconjunctival space to function as shunt and reduce the IOP.17,18 Various glaucoma management methods have had different effects on positional IOP elevations. In most cases, glaucoma medications have effectively reduced IOP; however, they fail to prevent the positional elevations in IOP.19,20 Argon and selective laser trabeculoplasty have been effective in reducing positional IOP changes.21,22 Trabeculectomy has also been effective.23–26