Surgical management of glaucoma includes various laser surgeries, filtering surgeries like trabeculectomy, and other procedures. Laser surgeries like argon laser trabeculoplasty and selective laser trabeculoplasty use laser energy to increase drainage by altering the trabecular meshwork. Trabeculectomy involves creating a small hole in the eye to allow drainage of fluid into a filtering bleb under the conjunctiva. Other options include non-penetrating surgeries, artificial drainage implants, and cyclo destructive procedures to ablate the ciliary body. The goal of all these surgeries is to lower intraocular pressure and slow glaucoma progression.

1. SURGICAL MANAGEMENT OF GLAUCOMAAbinaya.k.aRoll no:1

2. Surgical managementLaser surgeriesTrabeculotomy and goniotomyPenetrating filtering surgeries-trabeculectomyNon penetrating filtering surgeriesCyclo destructive proceduresArtificial drainage implants

3. LASER SURGERIESTrabeculoplastyPeripheral iridotomy-Nd:Yag laserCyclo ablation-diode laserLASER filtration proceduresArgon laserselective laser

4. TrabeculoplastyLaser energy to trabecular meshworkCellular changes in angleIncreases the drainagePatient selection:Patients non-compliant with med therapy.

5. Elderly

6. Type of glaucoma-open angle

7. Pigmentation-pseudo exfoliation type;-pigmentary

8. Pre-operatively:The eye should be free from inflammationIop should not be too highIt should not be end stage glaucoma

9. ARGON LASER TRABECULOPLASTYInvolves application of laser burns to the trabeculum at blue-green wavelengthsIt enhances aqueous flowAlt is ineffective in pediatric glaucoma and most of sec glaucoma except pigmentary and pseudo exfoliatory types

10. Application of laser beam:at the junction of pigmented and non pigmented trabeculum.Ideal reaction:minute gas bubble or blanching

11. Mechanism of actionMechanical effect:Tightening of TMOpening of intervening spacesOpening of collapsed schlemm’s canalBiological response:Release of cytokines-signals the macrophages to clear material that has accumulated in meshwork

12. procedurePre-op:brimonidine eye drops 15 mins beforeLocal anaestheticGonioscopic contact lens to visualise the angle180 or 360 treated per sessionPost-op:glaucoma eye drops,anti-glaucoma medication ot be continued,short course of topical steroidsFollow up-6 wks later

13. Complications:Peripheral anterior synechiae

14. Small hemorrhages

15. Elevation of IOP

16. uveitis

17. Adverse effect on subsequent filtering surgery

18. Success rate:POAG-75-80%selective LASER TRABECULOPLASTYNd:yag laser Laser targets only the pigmented cells in TMAdvantage over ALT-the surgeon can repeat the surgery over the same angle

19. peripheral iridotomyDefinition: -creating a full thickness hole in the peripheral iris in order to alleviate the pupillary block.

20. Indications:PACG

21. Fellow eye of a patient with acute glaucoma

22. Narrow occludable angles

23. Secondary angle closure with pupil block

24. Narrow angle in POAG

25. Combined mech glaucomaPeripheral iridotomy

26. TECHNIQUE OF IRIDOTOMYPUPIL IS MIOSED PRE-OPSITE:PERIPHERY OF IRIS,SUPERIOR IRIS11-1 o clock position TO PREVENT THE IRRADIATION OF FOVEA.SUCCESSFUL IRIDOTOMY:GUSH OF PIGMENT DEBRIS

27. COMPLICATIONS:BleedingIritisGlare and diplopiaCorneal burns

28. Surgery for congenital glaucomaGoniotomyTrabeculotomytrabeculectomy

29. goniotomyDone when cornea is clear or the angle can be visualised.Mech:Incision of obstructing trabecular meshworkDirect conduit between AC & schlemm canalBarkangoniotomy knife

31. Pre-op care:Acetazolamide:one week before to clear corneal opacityARI & NLD obstruction – treatedComplications:Post-op hyphemaInjury to iris & lensDM detachment

32. TRABECULOTOMYHarm’s trabeculotome

33. Filtering proceduretrabeculectomyPatient selection:

34. Pre-op considerations:Any type of glaucomaIntact,non-scarred conjunctivaSurgical technique:Incision through the conjunctica

35. Partial thickness scleral flap

36. A small hole in AC

37. Iridectomy at this point

38. Scleral flap closed with stitches