The document discusses a study evaluating the efficacy of punch trabeculectomy in treating different types of glaucoma. Forty-six eyes of 41 patients with primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma (PNAG), or acute congestive glaucoma underwent punch trabeculectomy surgery. The mean baseline and target intraocular pressures (IOP) were established for each patient based on diurnal measurements and individual risk factors. Post-operative follow ups evaluated IOP control and visual field scores to further adjust target IOP levels as needed to reduce glaucoma progression.

1. Efficacy of Punch Trabeculectomy in different typesof Glaucoma Dr. Anand Sudhalkar Baroda.

2. IOP & Glaucoma management IOP the only Modifiable risk Factor Relationship of the two well established(1,2) Establishing an Effective Target IOP the Key in management(3) Aim of glaucoma management is to maintain IOP below the Target to reduce field loss and improve optic nerve circulation(4) Ref 1. R. Vogel et al.BJO 1983; vol 67, 220-227, Ref 2. G. Gazzard BJO 2003; Ref 3. Popovi. Coll Antropol 2005; 29 Suppl 1:149-51. Ref 4. Anders Heijl. Arch Ophthalmol. 2002; 120:1268-1279.

3. Modalities for IOP reduction Topical drops Laser Trabeculoplasty Laser PI Filtration Surgery

4. Material & Classification 46 eyes of 41 patients POAG – 22 PNAG – 19 ACUTE CONGESTIVE – 5.

5. WORKUP Complete eye examination Gonioscopy Applanation tonometry Autoperimetry (Octopus)

6. Baseline & Target IOP Mean of diurnal IOP at 9am, 3pm and 8 pm. Target IOP derived individually considering Baseline IOP(5) Ref 5 Sonal D. Wadhwa Comp Ophthalmol Update 6: 259-65, 2005

7. Further adjustments to Target IOP Hartleben Formula Dynamic adjustments after follow up fields using Visual Field Scoring methods(6) Ref 6 Brenda W. Gillespie (Investigative Ophthalmology and Visual Science. 2003; 44:2613-2620.)