11th EUROPEAN GLAUCOMA SOCIETY (EGS) CONGRESS HIGHLIGHTS 2014
NICE - FRANCE 07- 11 JUNE 2014
Anne Coleman- USA
RF for onset of glaucoma: elevated IOP, age, race, family history, myopia, DH, migraine, elevated/low BP, CCT, steroid use, RF is modifiable.
Anders Heijl- Sweden
RF for progression: old age, race, IOP is key factor, no evidence of IOP fluctuation causing progression, PEX is independent RF, thin CCT, disc hemorrhage, sleep apnea, RF knowledge is important to set TP.
Jost Jonas- Germany
High incidence of glaucoma above - 6D myopia.
A rise in IOP causes laminar cribrosa thinning, ON shrinkage, exposure of posterior laminar cribrosa, bulging into cerebro spinal fluid, lamination of peripheral cribrosa causes optic pit. Translaminar pressure is fluctuating depending on arterial BP wave.
Colin O’Brien- Ireland
OD rim measurements may be highly predictive of future VF loss in glaucoma suspects.
Ingeborg Stalmans- Belgium
Optimizing trabeculectomy: peri-operative MMC or 5 FU can improve trabeculectomy outcome. Single intracameral 0.125mg Avastin improves success rate, less post –op needling, blebs are less vascularized. Avastin is as effective as MMC, a combination is more effective than MMC and can be reduced to 0.01% /1 minute.
F.J Goni- Spain
Post trabeculectomy early flat bleb introduce gentle pressure with an anaethestized cotton bud on radial scleral groove or 0.1ml 5 FU at 12.00 Hrs.
With enhanced OCT ( SD- OCT) we can gain insight into laminar, sclera, choroidal complex.
I Liebman –USA:
The risk of progression is 3 fold, often occurs in eyes with PPA, increased VF defect, DH at margin of VF defect, ? laminar and beam tear independent RF of DH: gender, ethnicity, PEX strong correlation between DH and structure/ function correlation. Key finding: careful disc examination, DH suggests ongoing and future progression, VFD, act with a DH!
S Gandolfi –Italy:
What if IOP is really low? pray!!!, think positively. How low and what is low? IOP measurements is in seconds ? accurate , estimate pressure. VF improvement after trabeculectomy, IOP drop can cause regeneration. Personalize you approach, further IOP reduction, if no response ask for help!
MMC /SFU: the beauty/ beast ?
The beauty: definitely tackles scarring, extremely effective against fibro vascular complex, MMC higher complete and qualified success than 5FU. The beast: ph 8.5 -9.0 so alkalized burn! MMC can penetrate down to ciliary body scleral melting hypotony, positive Seidel sweating bleb, infection, <2% endolphthalmitis, macular hypotony, OSD, blepharitis.
A.M.Fea – Italy:
What we know about NTG confirmed knowledge versus consensus: ONH pits/notches more often in NTG then in POAG, DH 20.5% in NTG, 8.3% in HTG, NTG: lots more localized, closer to fixation VFD, half progress in 7years untreated or treated, Brimonidine is neuro protective, RF? Vascular origin, marked nocturnal BP reduction, glaucoma progression with constriction of posterior ciliary artery, corneal hysteresis significantly less with NTG than POAG.
Peng Khaw- UK
Use 5FU , MMC, beta radiation to prevent scarring. Stop Aspirin pre-op, use Iopidine pre-op, subconjunctival xylocaine/adrenalin, aqueous flare after trabeculectomy is 1 day but after cataract months, use steroid and NSAI for 6 weeks, use local anaesthetic post – op against pain receptors and inflammation. Novel Avastin tissue tablet, slow release profile: 100mg, 96% released in 40 hours. Patient tailored treatment: control scarring, glaucoma progression, lower IOP to minimal risk area, long term maintenance (google search: Khaw and glaucoma)
A.Tuulonen – Finland
There is no scientific evidence that more care delivers better quality of life to our patients: good short term results, but bad long term results
Jan Schouten – Netherlands
Whether we should treat OHT is based on clinical judgement and cost. OHT with 22mmHg 4% risk, with 28mmHG 11% risk of conversion to POAG
C. Webers - Netherlands
Patients need to have TP < 15mmHg only with RoP, save sight and money with a low TP, start with a combo/ triple treatment, early laser, don’t withhold surgery!
Ivan Goldberg – Australia
Problem with imaging ONH, wide range of disc types, PPA, hemorrhage, with cataracts noisy scan, asteroid hyalosis CRVO
Garaway- Heath – UK
Imaging is as good as photos and quantifies.
B.Chauhan – Canada
With 2MD loss per year blindness in 10years! Do 5 VF tests in 2years to estimate MD loss / year, progression rate are variable.
P. Brusini – Italy
VF is still fundamental tool for diagnosis quantifying damage and FU of disease. 5dB loss in central 30 deg VF means already 50% RGC loss. VF: clinical judgement, defect classification, trend and event analysis, important to stage disease MD loss.
J.G. Feijoo – Spain
ICC glaucoma tubes? yes because complex glaucoma, progressive disease, endothelial damage, usually needs GDD, graft and cataract operation.
G.S.Megevand – Switzerland
Choice of end-stage glaucoma is trabeculectomy with MMC, only 6% loss of VA after end stage surgery.
J. Salmon – UK
Principles of treatment for secondary glaucoma: treat cause, control acute IOP elevation, reduce risk to fellow eye eg. DM, RVO, carotid artery occlusion. Acute NVG: steroids 1 hourly, Atropin, beta blockers, Diamox, Avastin 1.25mg rapid intravitreal ( window of opportunity), retinal laser PRP. Chronic NVG with IOP elevation: trabeculectomy with MMC, tube, cyclo-diode-laser.
K Barton – UK
With concomitant glaucoma and corneal disease manage glaucoma first then graft 0.5mm oversize, watch steroid induced IOP elevation.
R. Carassa - Italy
When previous vitreo-retinal surgery was done remove silicone oil, rather surgery with GDD because of conjunctival scarring, 82% success rate.