The problem of cataract management in the patients of glaucoma who have undergone fltering surgery is a challenging proposition for any surgeon, as the surgery can lead to several complications in the already compromised eye. As glaucoma requires lifelong management, the development of cataract is a significant concern because its treatment may lead to loss of intraocular pressure (IOP) control. This review aims to highlight the intra- and postoperative measures that may increase the chances of bleb survival following cataract surgery.
Glaucoma is an optic neuropathy leading to changes in the intrapaillary and parapaillary regions of the optic disk. Despite technological advances, clinical identification of optic nerve head characteristics remains the first step in diagnosis.
Careful examination of the disk parameters including size, shape, neuroretinal rim shape and pallor; size of the optic cup in relation to the area of the disk; configuration and depth of the optic cup; ratios of cup-to-disk diameter and cup-to-disk area; presence and location of splinter-shaped hemorrhages; occurrence, size, configuration, and location of parapapillary chorioretinal atrophy; and visibility of the retinal nerve fiber layer (RNFL) is important to differentiate between the glaucomatous and nonglaucomatous optic neuropathy.
The pediatric glaucomas present some of the greatest clinical challenges. Uveitic glaucoma is a pathology whose causes and treatment are still a great enigma to all glaucoma specialists. We describe the spectrum of pediatric uveitic glaucoma along with its risk factors and the outcome of treatment in this subgroup. Our paper aims to review the existing literature on the subject and throw light on how to manage these cases.
Pseudoexfoliation (PXF) syndrome is a well-recognized clinical entity of considerable clinical significance. It is associated with poor mydriasis, cataracts with weak zonular support, secondary glaucoma and possibly with biochemical abnormalities, such as elevated homocysteine and systemic diseases involving the cardiovascular and central nervous system. There have also been some recent studies identifying mutations in genes which are associated with PXF.
Glaucoma, given its insidious nature, is often coined ‘the sneak thief of sight’. Following this trail of thought, primary open angle glaucoma with low or normal tension (POAGLNT) could be coined ‘the king of thieves’. The lack of a compelling red fag of high intraocular pressure (IOP), together with the diurnal fuctuation of the deceptively low baseline IOP, POAGLNT poses a therapeutic challenge in terms of judging when to intervene, and how.
In this review article, we will outline the considerations before undergoing surgery: risk stratification, defining goal in terms of target pressure and IOP modulation. We will also review the strengths, weaknesses and pearls of available options.
Mentorship programs have been found to be of great use in all career fields, especially medicine. Given that the practice of medicine is best learnt by a hands-on training, a mentorship program can prove invaluable for the young clinician scientist. A structured super-speciality training program can help in both, acquisition of clinical and research skills, as well as career growth.
Gabriel Enrique Ortiz Arismendi,
Cristina Del Pilar Peña Valderrama,
How to cite this article:
Ortiz Arismendi GE, Peña Valderrama CD, Albis-Donado O. Results of a New Technique for Implantation of Nonrestrictive Glaucoma Devices. J Curr Glaucoma Pract 2013; 7 (3):130-135.
Objective: To describe and present results of an original technique for nonvalved glaucoma implants.
Patients and methods: Thirty-five eyes of 34 patients with aggressive and/or advanced glaucomas of different causes were included. A Baerveldt implant was used in all cases, using an absorbable ligature that had been titrated to allow fow from day 1, but avoiding hypotony. Intraocular pressure (IOP) during the first 8 weeks, final IOP, visual acuity and complications were analyzed.
Results: Mean preoperative IOP was 42.8 mm Hg (range: 24-64 mm Hg). IOP was 14.4, 17.2, 18.6, 19 and 16.4 mm Hg during the 1, 2, 4, 6 and 8 postoperative weeks. Mean final IOP was 13.8 ± 4.25 mm Hg, a 67.8% reduction, after a mean follow-up time of 13 months (range: 8-29 months). Twenty-nine eyes (82.9%) had complete success, two had qualifed success (5.7%) and four were failures (11.4%). Choroidal detachments and transient tube obstructions were the most frequent complications.
Conclusion: Titrated ligature of Baerveldt tubes was effective for controlling IOP during both the early and late postoperative phases in eyes with severe glaucomas.