The early reports on intraocular bevacizumab injections talked about a transient predictable probably volume-related rise in intraocular pressure (IOP). As the usage of the drug increased across the globe, sustained IOP elevation was noted. This article provides an insightly into the causes of IOP spikes and its impact on glaucoma practice.
In this editions\' ‘Experts Opinion’, the management of hy-potony and choroidal effusion following glaucoma filtration surgery is discussed. We are delighted to welcome Clinical Associate Professor Ivan Goldberg and Professor Franz Grehn and Paul Chew to the panel to provide opinion on this very challenging clinical situation.
Purpose: To provide an update on the role of optic nerve head and peripapillary retinal nerve fiber layer imaging in monitoring glaucoma progression.
Methods: Review of literature.
Results: Imaging technologies, such as optical coherence tomography, scanning laser polarimetry, and confocal scanning laser ophthalmoscopy, objectively and quantitatively measure the structural change associated with glaucoma. Rates of retinal nerve fiber layer (RNFL) and rim area loss are significantly faster in progressing compared with nonprogressing subjects. A number of strategies to detect progression have been proposed. The precision of these methods is generally high. However, there is no agreement as to which instrument or parameter is most appropriate for the evaluation of structural progression associated with glaucoma at this moment. The agreement between structural and functional glaucoma progression is generally poor regardless of the strategies used. Structural progression analyses appear to complement visual field progression analyses, detecting a different subset of progressing subjects.
Summary: Imaging devices are promising tools for monitoring patients with glaucoma. Combining structural and functional analyses is useful for accurate monitoring of glaucoma progression.
Source of support: Nil
Conflict of interest: None declared
Dennis SC Lam,
Christopher K Leung
How to cite this article:
Li H, Jhanji V, Dorairaj S, Liu A, SC Lam D, K Leung C. Anterior Segment Optical Coherence Tomography and its Clinical Applications in Glaucoma. J Curr Glaucoma Pract 2012; 6 (2):68-74.
Anterior segment optical coherence tomography (ASOCT) is an imaging modality that provides both quantitative and qualitative information on the cornea, anterior chamber angle, iris and crystalline lens. ASOCT shows excellent repeatability and reproducibility for the measurement of corneal thickness, anterior chamber angle and anterior chamber depth. With realtime video recording, ASOCT can also effectively capture the dynamic changes of the iris and lens in response to light and eye accommodation. With this additional information, physiological and pathological changes of the anterior segment structures are now better understood. This article aims to provide an overview of the current applications of ASOCT in glaucoma.
The use of antivascular endothelial growth factors such as bevacizumab and ranibizumab has brought about a revolution in management protocols of various ophthalmic disorders. A lot has been written about these agents, still lacunae exist in our understanding due to paucity of randomized control trials with large number of patients. This brief review attempts to throw light on the clinical applications of these molecules for glaucoma.
Given the obvious quality of life concerns with medical and surgical lowering of intraocular pressure (IOP), lasers have received considerable attention as a therapeutic modality for glaucoma.
Selective laser trabeculoplasty (SLT) is increasingly being used in clinical practice as both the primary procedure and as an adjunct to medical and surgical therapy. Preliminary published evidence suggests that SLT is an effective, compliance-free, repeatable and safe therapeutic modality having only minor, transient, self-limiting or easily controlled side effects with no sequelae.
This review attempts a broad overview of the current knowledge of its mechanism, efficacy, indications and limitations, point out the knowledge lacunae that still exist with respect to this highly promising technology which has captured the attention of glaucoma surgeons all over the world.
Scott J Fudemberg,
Marlene R Moster
How to cite this article:
Ichhpujani P, Prasad A, J Fudemberg S, R Moster M. The Blitz Anesthesia Technique in Non-English Speaking Patients Undergoing Glaucoma Surgery. J Curr Glaucoma Pract 2012; 6 (2):91-93.
Aim: To describe a less invasive method of providing anesthesia in non-English speaking patients undergoing glaucoma surgery.
Settings and design: Prospective observational study conducted in a tertiary Care Eye Institute, Wills Eye Institute, Philadelphia, PA, USA.
Materials and methods: The blitz anesthesia technique was applied to 15 non-English speaking patients (Vietnamese, Mandarin, Russian and Korean) during glaucoma surgery. With input from family members, a diagram was created for each patient. The diagram consisted of a translation and phonetic guide to pronunciation of common words or phrases in the patient\'s native language that might be used by the surgical team during the operation.
Results: The blitz anesthesia technique worked well to provide patient comfort during the procedures. All patients reported adequate pain control and described their experience as comfortable. Additionally, patients reported feeling reassured that they were able to understand basic information from the surgical team during their case. This technique decreased patient anxiety prior to and during the surgical procedure.
Conclusion: Blitz anesthesia provided adequate pain control with no complications.
Key message: Blitz anesthesia with a phonetic language diagram, a less invasive technique of providing anesthesia in non-English speaking patients undergoing glaucoma surgery.
Bleb revision for hypotony maculopathy following trabeculectomy is an effective technique for raising intraocular pressure and limiting visual loss. The presence for scleral fistula causing over-filtration obviates the need for reinforcing materials, such as donor sclera or pericardium to cover the defect. However, if the surrounding scleral tissue is healthy, a partial thickness scleral flap can be upturned and sutured over the fistula. Moreover, a vascularized pedical conjunctival graft can also be used in cases where there is a large conjunctival defect.