Efficacy of Punch TrabeculectomyPresentation Transcript
Efficacy of Punch Trabeculectomy in different types of Glaucoma Dr. Anand Sudhalkar Baroda. Acknowledgements: Dr. Sandhya Dr. Shubhangi Ms. Dhruti Mr. Mayank Rao
IOP the only Modifiable Risk Factor in glaucoma management
Maintaining IOP below the Target reduces field loss and improves optic nerve circulation.
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AIM:To compare the IOP lowering efficacy M edical treatment v/s Standardized Punch trabeculectomy surgery without anti-metabolites.
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46 eyes of 41 patients subjected to Punch Trab. after Trial of medical treatment.
POAG – 22
PNAG – 19
ACUTE CONGESTIVE – 5.
Complete eye examination
Mean Baseline IOP: with Non Contact Applanation tonometry at 8 am, 3 pm and 8 pm
Mean Baseline IOP and Age group
Target IOP calculations
Initial Target IOP: 20 to 40% reduction from Baseline IOP
Sonal Wadhwa, Comprehensive ophthalmological update volume 6, in November 2005 .
Dynamic Resetting Target by quantifying Fields
The VF score is calculated as follows: First, neighboring points are defined as those adjacent to a given point, whether on a side or a corner. Each of the 52 points in the field is individually graded. A point is called defective if its probability is 0.05 or less, and it has at least two neighboring points with probabilities of 0.05 or less in the same vertical hemifield (superior or inferior). A weight is assigned depending on the minimum depth of the defect at the given point and the two most defective neighboring points. A minimum defect of 0.05, 0.02, 0.01, and 0.005 is given a weight of 1, 2, 3, and 4, respectively. A point without two neighboring points all depressed to at least P ≤ 0.05 is given a weight of zero. For example, a point at P ≤ 0.01 with only two neighboring points of defect, both at P ≤ 0.05, would receive a weight of 1. The weights for all 52 points in the field are summed, resulting in a value between 0 and 208 (52 x 4). The sum is then scaled to a range of 0 to 20 (dividing the sum by 10.4), to yield values in the same range as the VF score previously developed by the Advanced Glaucoma Intervention Study (AGIS). 1 The resultant score is a nearly continuous measure of VF loss.
Further reduced by deducting the mean deviation from the field report.
(Dr. Curt Hartleben)
Brenda W. Gillespie (Investigative Ophthalmology and Visual Science. 2003; 44:2613-2620.)