Highlights from the 2^nd WGA Consensus Meeting: Glaucoma Surgery - Open Angle Glaucoma

April 30, 2005, Fort Lauderdale, FL, USA

• Clinicians should generally measure IOP more than once and preferably at different times of the day when establishing baseline IOP prior to surgery. When IOP is markedly elevated, a single determination may be sufficient.
• Efforts should be directed at estimating the rate of risk of progression. A greater rate of risk of progression may lower the threshold for surgery but must be balanced against the risk and benefits of surgery and the life expectancy of the patient.
• All commonly employed methods of LTP appear to be equivalent with respect to short-term side effects and IOP lowering.
• There is longer follow-up data available for argon laser trabeculoplasty (ALT) than for selective laser trabeculoplasty (SLT). Randomized studies comparing these two modalities are not yet available.
• Retreatment with ALT (applying additional laser spots to areas of the meshwork previously treated) is likely to be ineffective and perhaps detrimental.
• The use of adjunctive antifibrosis agents should be considered in most patients undergoing trabeculectomy and should be titrated against the estimated risk of postoperative scar formation and estimated risk for postoperative complications.
• Modern trabeculectomy techniques that include the use of lasered/releasable/adjustable sutures should be employed to mini-mize the complications of excessive filtration.
• Trabeculectomy is the incisional procedure of choice in previously unoperated eyes.
• Trabeculectomy provides better and more sustained IOP lowering than non-penetrating procedures.
• Trabeculectomy successis highly dependent on postoperative care and management.
• A combined procedure is usually indicated when surgery for IOP lowering is appropriate and a visually significant cataract is also present.
• Mitomycin-C should be considered in all combined procedures to improve the chance of successful IOP control, unless there is a clear contraindication for its use.
• Combined procedures are less successful for IOP reduction than trabeculectomy alone.
• In patients with cataract and stable glaucoma, a clear corneal approach is preferable in patients who may require subsequent trabeculectomy.
• The restrictionof flow of aqueous humor from the eye is important in the prevention of immediate postoperative hypotony.
• Scar formation around the plate is the main cause of long-term device failure.
  Comment: Antifibrotic agents have not been shown to improve long-term success when used intraoperatively or postoperatively.
• With increased conjuctival scarring, the usccess of MMC trabeculectomy is reduced. Aqueous shunting procedures should be considered in patients with failed MMC trabeculectomy.
• Bleb related complications are less prevalent after aqueous shunting procedures. However, aqueous shunting procedures introduce a distinct set of complications including tube erosion or plate erosion, endothelial decompensation and strabismus.
• Failed NPGDS may compromise the success of subsequent trabeculectomy.
• Lower IOP can be achieved with trabeculectomy than with NPGDS.
• Short-term complications associated with NPGDS may be fewer and less severe.
• Non-Penetrating Glaucoma Drainage Surgery is technically more challenging, with a longer operative time.
• Transscleral cyclophotocoagulation may be considered when maximal medical therapy, trabeculectomy or drainage implant surgery is not possible due to resource limitations.
• Glaucoma Drainage Device implantation requires greater surgical training and is a more extensive procedure than cyclodestruction.
• The marginal cost of GGD implantation is more expensive than cyclodestruction. The initial cost of cyclodestruction related to the purchase of the device used for the procedure may be greater than that with GGD implantation.

WGA Consensus Meetings Publications

Consensus Series 3 Angle Closure and Angle Closure Glaucoma, edited by By: R.N. Weinreb & D.S. Friedman

Publication year: 2006. xiv and 98 pages with 59 figures of which 3 in color, 1 table. Hardbound. ISBN 10: 90-6299-210-2 ISBN 13: 978-90-6299-210-2 € 45.00 / US $ 56.00 Available at your local bookstore and directly from the publisher. Click here for details On IGR web: 3rd WGA Consensus Meeting statements: Angle Closure and Angle Closure Glaucoma

Consensus Series 2 Glaucoma Surgery: Open Angle Glaucoma, edited by Robert N. Weinreb and Jonathan G. Crowston

Publication year: 2005. xiv and 140 pages with 9 tables and 2 figures, of which 1 in full color Hardbound. Kugler Publications, The Hague, The Netherlands. ISBN 10: 90-6299-203-X ISBN 13: 978-90-6299-203-4 € 50.00 / US $ 60.00 Available at your local bookstore and directly from the publisher. Click here for details On IGR web: 2nd WGA Consensus Meeting statements: Glaucoma Surgery: Open Angle Glaucoma

Consensus Series 1 Glaucoma Diagnosis. Structure and Function, edited by Robert.N. Weinreb & Erik. L. Greve

Publication year: 2004. viii and 152 pages with 17 figures, of which 12 in full color, and one table. Hardbound. Kugler Publications, The Hague, The Netherlands. ISBN 10: 90-6299-200-5 ISBN 13: 978-90-6299-200-3 € 50.00 / US $ 60.00 Available at your local bookstore and directly from the publisher. Click here for details Meeting pictures     Issue 8-2 Table of Contents Editor's Selection Change Issue 25-124-424-324-1/223-423-323-223-122-422-322-222-121-421-321-221-120-420-320-220-119-419-319-219-118-418-318-218-117-417-317-217-116-416-316-216-115-415-315-215-114-414-314-214-113-413-313-213-112-412-312-212-111-411-311-211-110-410-310-210-19-49-39-29-18-48-38-28-17-37-27-16-36-26-15-35-25-14-34-24-13-33-23-12-32-22-11-31-21-1 advertisement