Glaucoma is a condition of the eye when the optic nerve of the eye becomes weak, usually because of a rise in pressure within the eye (Intraocular pressure). Malignant glaucoma is a rare condition when the pressure goes up because of a misdirection of aqueous humour within the eye.....
Glaucoma is a condition of the eye when the optic nerve of the eye becomes weak, usually because of a rise in pressure within the eye (Intraocular pressure). Malignant glaucoma is a rare condition when the pressure goes up because of a misdirection of aqueous humour within the eye.....
Presentatie "Gedrag belangrijker dan inrichting" IdexxYNNO
Op 19 november hebben Pennie Arbouw-Heimans (IDEXX) en Frederik van Steenbergen (YNNO) op het congres OHNW 2013 deze presentatie "Ander gedrag belangrijker dan nieuwe inrichting" gegeven.
Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glauco...CrimsonpublishersMSOR
The aim of this study was to investigate the long-term effect of selective laser trabeculoplasty in open angle glaucoma patients as a replacement for medical therapy. 64 eyes of 64 primary open angle glaucoma (POAG) patients under therapy with glaucoma drugs and controlled Intra Ocular Pressure (IOP) were reviewed for 36 months. 360o selective laser therapy (SLT) sessions were performed in two sessions and the medical therapy was stopped. The patients were controlled and evaluated postoperatively 1, 3, 6, 12, 24 and 36 months after surgery for glaucoma progression. In 36 (56.3%) of the 64 patients SLT was successful and there was no need to medical treatment at 36th month. In 28 patients (43.7%) medical treatment was started due to IOP rising. In Logistic regression analysis baseline IOP was found to be significantly effective on success rate of SLT (R2: 0.718, p<0.001).
medical management of chronic open angle glaucoma, primary angle closure glaucoma after iridotomy, normotensive glaucoma and acute angle closure attack.
The objective of this study was to observe the 1-year and 2-year pressure reduction in an active population of glaucoma patients treated by selective laser trabeculoplasty. We carried out a retrospective study of all patients treated in our department between January 2015 and March 2016. Patients who had already undergone Laser Trabeculoplasty (ALT or SLT) in the past were excluded from the study. Treatment was performed with a Q-Switched, frequency doubled Nd: YAG laser (Solutis - Quantel Medical, France), over 180° or 360° of the trabecular meshwork. The mean decrease in intraocular pressure and the success rate, defi ned as a decrease in intraocular pressure superior to 20% without increasing the medical treatment, were calculated. The impact of the different clinical and technical characteristics on the decrease in pressure was also studied by multivariate analysis.One hundred and seventeen eyes, in 74 patients, were included. The mean decrease in IOP from baseline was 4.35 mmHg (20.6%) at 1 year and 3.74
mmHg (16.7%) at 2 years. The success rate was 49% at 1 year and 33.3% at 2 years. Selective trabeculoplasty is currently a therapeutic option called-upon at different stages in the progression of glaucoma. The duration of effi cacy of this laser therapy, and the retreatment frequency are yet to be defined.
The objective of this study was to observe the 1-year and 2-year pressure reduction in an active population of glaucoma patients treated by selective laser trabeculoplasty. We carried out a retrospective study of all patients treated in our department between January 2015 and March 2016. Patients who had already undergone Laser Trabeculoplasty (ALT or SLT) in the past were excluded from the study. Treatment was performed with a Q-Switched, frequency doubled Nd: YAG laser (Solutis - Quantel Medical, France), over 180° or 360° of the trabecular meshwork. The mean decrease in intraocular pressure and the success zrate, defi ned as a decrease in intraocular pressure superior to 20% without increasing the medical treatment, were calculated. The impact of the different clinical and technical characteristics on the decrease in pressure was also studied by multivariate analysis. One hundred and seventeen eyes, in 74 patients, were included. The mean decrease in IOP from baseline was 4.35 mmHg (20.6%) at 1 year and 3.74 mmHg (16.7%) at 2 years. The success rate was 49% at 1 year and 33.3% at 2 years. Selective trabeculoplasty is currently a therapeutic option called-upon at different stages in the progression of glaucoma. The duration of effi cacy of this laser therapy, and the retreatment frequency are yet to be defined.
Learning Effect and Test-Retest Variability in Healthy Subjects and Patients ...inventionjournals
Aim: To study learning effect (LE) and test retest variability (TRV) in healthy subjects and patients with primary open angle glaucoma (POAG) using Rarebit perimetry (RBP). To determine normative ranges of RBP. Methods: 61 eyes of 35 subjects underwent visual field testing with standard automated perimetry (SAP) and RBP. TRV and LE were assessed in repeated examinations conducted in 3 different days. First two examinations were conducted within 3 days and the last one within one month. LE was assessed by comparing results from the three sessions. TRV was evaluated by calculating differences between retest for each combination of single tests. To determine normative ranges of RBP were included 34 eyes of 21 healthy subjects and 62 eyes of 47 subjects with preperimetric and early POAG. Cut off value was determined between the two groups using ROC analysis. Results: No significant LE was observed in POAG group. There was a significant LE in the control group but only in the visual field zones with eccentric location. TRV was higher in POAG group and in central visual field zone. The mean MHR in control group was 94.88 (SD 2.21) and 83.56 (SD 6.95) in POAG group. Cut off value for discriminating between healthy subjects and patient with POAG was 91.50% with AUROC 0.985 (p<0.001, ROC analysis). Conclusion: RBP is fast and easy to perform test. RBP testing did not show a significant LE in glaucoma group, however, TRV was consistent. MHR can be successfully used for differentiation of healthy eye from those with early glaucoma changes.
Novel Development in treatment of Diabetic Macular Edema, by Dr. Fritz Allen, presented at VO, Lecture Series 11, Feb 20, 2011
COPE Course ID: 30657-PS
Apart from its established role in Age related maculopathy, Ani-Vegf have other usage too. Presently clinical study reports are coming in showing encouraging results.
oECCE with posterior chamber intraocula lens implantation achieves results equal to phacemulsification in expert hands and has been an accepted method of cataract surgery.
1. Efficacy of Punch Trabeculectomy in different types of Glaucoma Dr. Anand Sudhalkar Baroda. Acknowledgements: Dr. Sandhya Dr. Shubhangi Ms. Dhruti Mr. Mayank Rao
Efficacy of Punch Trabeculectomy as an IOP lowering modality in various type of Primary Glaucoma. Let me acknowledge the help rendered by my wife Dr. Sandhya, assistants, Dr. Shubhangi and Miss Dhruti in going through the case records and scrutinizing the perimetry charts. Special thanks to Mr. Mayank Rao for the biostatistical help with SPSS software.
IOP is the only modifiable risk factor in glaucoma management. Relation between the two is well documented by Vogel and Gazzard in British Journal of Ophthalmology. Aim of glaucoma therapy, till today, is to establish a target IOP as mentioned by Popovi and to maintain the diurnal pressure below the target to reduce the field loss and improve optic nerve circulation as documented by Anders in Archieves.
Several expensive medications with tall claims were compared with a standardized punch trabeculectomy technique applied to various types of primary glaucoma.
Case records of 46 eyes of 41 patients of primary glaucoma, who after a fair trial of medical treatment had to eventually undergo Punch trabeculectomy without antimetabolites as a primary procedure were studied. They were classified from their Gonioscopic findings as Primary Open angle (POAG), Primary Narrow Angle (PNAG) and Acute congestive glaucoma.
All cases underwent complete ocular examination including Gonioscopy, Applanation Tonometry and Autoperimetry.
Initial Target was set at 20 to 40% reduction from baseline IOP as per the Glaucoma clinical trial guidelines shown by Sonal Wadhwa in her publication.
This was Dynamically modified by scrutinizing the follow up fields applying the visual field scoring technique recommended by Brenda Gillespie in her publication. When the fields showed deterioration, the target was further reduced by deducting the mean deviation from the field report, as recommended by Dr. Curt Hartleben
Slide 12. Results: Mean pretreatment IOP 22 to 51 mm Hg with mean at 32.4 and standard deviation of 7.21. 13 eyes each in POAG and PNAG group had baseline IOP less than 30. Target IOP raged from 5mm to 19mm Hg with mean at 12,3 and standard deviation of 3.25. This amounted to 60.2% mean reduction with standard deviation of 12.31.
Medical management to meet the goal,
Apart from uncontrolled IOP and unabated field loss in spite of maximum tolerated medical therapy, other indications to consider filtration surgery were, non compliance or intolerance to multiple drugs and associated significant cataract. 10 eyes underwent only trabeculectomy and 26 were combined with phacoemulsification using a separate temporal clear corneal incision as a primary procedure.
Slide 10 Fornix based 6×9mm conjunctival flap made in upper nasal quadrant as per the reference of A. K. Negi and Vernon. Triangular scleral partial thickness flap designed with 4mm base and height 3mm. After a separate clear corneal paracentesis away from filtration site, the anterior chamber opened at the base of the triangular flap and 0.75mm scleral window removed with Kelly’s punch. A peripheral button hole iridectomy was made and scleral flap closed with two side 10/0 sutures and one apical suture. Conjunctiva was closed by two interrupted 10/0 sutures taken with scleral bite first to achieve buried knots. When combined with cataract surgery, a temporal clear corneal incision was taken for phacoemulsification Post Surgery medications: Steroid with antibiotic drops qid for one month. Atropine drops tid for first 7 days.
Slide 11. . Surgery post op Follow ups were done on 1st, 7th 15th and 30th days and every month for minimum 6 months thereafter. Slit lamp examination, non contact applanation tonometry, BCVA and retinal examination done at each visit for first month to identify complications like bleb leak, infection, choroidal effusions, retinal hemorrhages, edema and IOP. Bleb formation was checked on slit lamp by gently applying pressure on temporal sclera during initial month. Conjunctival sutures were removed if required after 2 months post op. Post op follow up ranged from 6 months to 2 years with mean 11 months.
Slide 21 Comparison between trabeculectomy done alone and trabeculectomy With temporal clear corneal phaco showed the mean IOP fqall in trab alone was 66.13% against 56.28% in trab+phaco group. Ref. Lochhead J BJO 2003;87(7)850-2 compared separate trab incision with phacotrab single incision and found separate incisions better for IOP reduction.
Slide 22 Surgery alone was completely successful in reaching the target IOP in 35 out of 46 eyes (76%). Post surgical topical medication became necessary in 11 out of 46 eyes to maintain the target IOP. 7 reached the target with single drug post op to achieve qualified success (15.2%). 4 eyes out of 46 continued to have IOP higher than the set target to be labeled as failures (8.6%).