Glaucoma

Its almost time to close the door on 2006 and welcome another new year. But, before we do that we wanted to take you on a journey through the highs and lows of the past twelve months by reflecting on some of the most significant events to shape your industry this year.

Many doctors using ECP undertreat patients, which leads to unnecessary retreatments. This is understandable, as there is a fear of the consequences of over-treatment with ECP, but I have rarely, if ever, seen this

The significant relationship [between cost and stage of disease] demonstrates the important economic repercussions in health care systems world wide, if glaucoma is not dealt with quickly

Phacoemulsification with IOL implantation, in eyes with PACG, allows us to achieve not only high visual acuity, but also to create favourable conditions for aqueous humour outflow.

Combined surgical management of coexisting cataract and glaucoma has recently gained popularity because of the several advantages that it presents. These advantages include, decreased risk, easier management of early and long-term postoperative intraocular pressure (IOP) and performing just one surgical procedure to manage both problems.

The management of paediatric glaucoma is primarily surgical. In the literature, goniotomy and trabeculotomy, despite success rates of only 40-90%, are still the initial surgical procedures of choice for most cases of primary congenital glaucoma. In the case of secondary glaucomas associated with conditions such as aphakia, aniridia, anterior segment dysgenesis and Sturge-Weber syndrome, the success rates of goniotomy or trabeculotomy are much lower.

Open angle glaucoma can be considered as a pathology, which predominantly requires surgical treatment. In light of this, John Cairns, in 1968, introduced a "protect filtering" surgical technique that would improve aqueous outflow and reduce intraocular pressure (IOP) in glaucomatous eyes. That technique was called trabeculectomy.

Deep sclerectomy is not the holy grail of glaucoma surgery, but available evidence indicates that it is definitively safer than trabeculectomy, according to Tarek M. Shaarawy, MD.

The challenge of glaucoma surgery is not only to create a canal within the anterior chamber that acts as a pressure alleviator, it is to ensure that the canal is stable, will not close and, preferably, will alleviate intraocular pressure (IOP) to such an extent that medication is either no longer necessary or the frequency of dosing is minimized. This is the goal of every glaucoma surgeon and one that, unfortunately, is often not achieved, for a number of reasons.

Ophthalmology is a branch of medicine that we, as ophthalmologists, regard as an elite branch of medicine and others, such as general surgeons and physicians, often consider as a minor and sometimes easy discipline. As a result of this misdirected preconception, a general practitioner, consultant or physician may not feel it necessary to fully inform us of a patient's health record because they do not consider that ophthalmic medications could, potentially, carry with them serious, sometimes life threatening side effects, if used inappropriately.

Many ophthalmic disorders give rise to neovascularization of the iris and neovascular glaucoma. Almost all of these disorders are characterized by retinal hypoxia and retinal capillary nonperfusion, the same factors involved in the development of retinal neovascularization. One of the most common causes is central retinal vein occlusion (CRVO), which is a visually disabling disease that is second in prevalence only to diabetic retinopathy.

Research, development, innovation and the quest for excellence go hand in hand with the evolution of the ophthalmology industry. With the new wave of phakic IOLs entering the market, each with its own unique offering and capabilities, it's hard to know which lenses will suit you and your patient best. Furthermore, does the introduction of these new refractive correctors threaten the position of the lasers that we have all come to grow to love? It seems that the laser refractive surgery industry is still going from strength to strength.

Twenty-five years ago, our algorithm for glaucoma treatment was drop, drop, drop, pill, laser, surgery

Conventional trabeculectomy aims to control IOP by way of a guarded fistula between the anterior chamber and sub-conjunctival space via leakage past the scleral flap. The resulting bleb is often seen to form under the anterior conjunctiva, where Tenon's layer and the conjunctival tissue are thinnest, predisposing patients to bleb-related complications at or near the limbus. Complications include cystic bleb formation, blebitis, endophthalmitis, dellen ulcer and bleb dysaesthesia, the use of anti-metabolites often compounding these problems.

Since the late 1960s, trabeculectomy has been the operation of choice for improving aqueous outflow in glaucomatous eyes. Still today it remains the gold standard for glaucoma filtration surgery, with ophthalmologists accumulating a considerable amount of experience with the procedure, its advantages and its limitations.

Unlike trabeculectomy, canaloplasty is a non-penetrating procedure that reduces the chance of inducing cataract or causing anterior segment inflammation

The surprising outcomes of the European Glaucoma Prevention Study (EGPS) can be accounted for by a number of explanations and should not be interpreted as meaning that lowering IOP has no benefit for glaucoma, said Harry A. Quigley, MD.