GUEST SPEAKER: PAUL PALMERG
BASCOM PALMER EYE INSTITUTE, MIAMI, FLORIDA, USA.
ONE YEAR RESULTS TUBE VERSUS TRABECULECTOMY STUDY (TVT):
Non-valved tube shunt surgery was more likely to maintain IOP control and avoid persistent hypotony and re-operation for glaucoma than trabeculectomy with MMC during the first year follow up.
Tube shunt surgery and trabeculectomy with MMC produced similar IOP reduction at 1 year. There was less need for supplemental medical therapy with trabeculectomy. The incidence of postoperative complications was higher following trabeculectomy with MMC than non-valved tube shunt surgery.
SLITLAMP PROCEDURES IN GLAUCOMA MANAGEMENT WITH A 30 GAUGE NEEDLE:
Decompressing high pressure, eg. an angle-closure attack, needling failing blebs to cut scleral membranes or to pull iris free out of the angle or to cut the pupil membranes and free drainage tube tips.
WHAT IS IT ABOUT PRESSURE THAT MATTERS IN GLAUCOMA?
Epidemiological studies in European and American populations suggest that only one-third of glaucoma damage is associated with an excess intraocular pressure. There is a “dose-response” relationship between the IOP and the risk of VF damage. CIGTS shows that a 35% IOP reduction eliminates the need for measuring diurnal pressures.
Reaching and sustaining IOPs below appropriate target pressures succeeds in reducing the risk of progression. This does not eliminate the possible benefit of measuring diurnal pressures in NTG patients, or in those whose IOP is on borderline control.
Mean IOP matters especially in advanced cases, no ROP with maximum IOP 14mmHg.
MANAGING PAINFUL DRAINAGE BLEBS:
1. A high drainage bleb producing Dellen and bubble dyesthesia use two scleral anchored 9.0 nylon matress sutures to flatten the bleb.
2. A large bleb overhanging the limbus needs to be excised at the limbus after lifting it with a spatula.
3. A circumferential elevated drainage bleb can be flattened with multiple cautery applications and using cotton buds to express the fluid.
For gonioscopy use a Zeiss four mirror lens, use no fixation light, turning up the light will open the angle, so darkened conditions. The Goldmann contact lens suction effect opens the angle and one misses angle-closure.
Do not rush in to new procedures, never be impressed by six months results only, five year results are the minimum to change your technique.
Paul Palmberg Topics for SAGS Congress 2008:
How much of glaucoma damage is pressure-dependent?
Gonioscopy in the laser age
How to use MMC safely in glaucoma surgery
The management bleb problems and hypotony
Glaucoma drainage devices--new techniques
Slit-lamp procedures in glaucoma management--"Micro Zorro"
Winner: Dr Riel de la Bat - UOFS
Second: Dr Phillip Kraukamp- St Johns
Third: Dr Barry Payne- St Johns
Four: Dr Shelley Barret- UOFS