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Go to: 1. The point-wise impressions of the chairmen Session 1: Subjective assessment Session 2: Ocular imaging Session 3: Genetics and childhood glaucoma Session 4: Blood flow and miscellaneous Session 5: Medical treatment Session 6: Antiproliferatives Session 7: Surgery and NPFS Session 8: Nonpenetrating filtering surgery 2. A selection from the interactive question and answer system 3. EGS award winners   Session 5: Medical Therapy by Clive Migdal • The session on medical therapy commenced with an overview outlining the various therapies, both old and new, that are used to treat glaucoma, but emphasized that medical therapy is really focused on lowering intraocular pressure, one of the risk factors of the disease. Further understanding of the causes of ocular ischaemia, or the concept of neuroprotection, may in the future modify our approach to treatment. • A number of studies compared safety and efficacy of different drugs. A new ocular hypertensive lipid ( AGN 192024) found to be safe and well-tolerated, providing an ocular hypotensive effect superior to timolol, and at least as efficacious as latanoprost. Large scale clinical evaluations are under way. • Latanoprost monotherapy was shown to be a possible alternative to therapy with dorzolamide combined with timolol in a randomized multicentre study. In another study, a meta-analysis of pooled data from eight multicentre studies showed that latanoprost was significantly more effective than timolol in reducing intraocular pressure. • Brimonidine was also shown to be safe and well tolerated in adults following long-term use, with an equivalent IOP-lowering effect to timolol. When used as adjunctive therapy, it produced a greater drop in IOP compared with dorzolamide. • Several papers dealt with the effects of latanoprost on pigmentation. In Japan, it is claimed there is a higher rate of increased iris pigmentation than in European or American eyes. Another study claimed that, in the first three months of therapy, latanoprost is more effective in eyes that show an increase in iris pigmentation. Increased pigmentation has also been shown in the trabecular meshwork of patients treated with latanoprost. The newer medications do cause changes in the conjunctiva and the tear film breakup time, as expected. The effect may be related to the amount of preservative present. • An interesting study investigated the presence of kynurenic acid, an NMDA antagonist, and potential neuroprotectant, in the human and rabbit vitreous body, and showed that amniooxyacetic acid, a KYNA synthesis inhibitor, when injected into the vitreous, decreased intravitreal concentration of KYNA, suggesting an intraocular origin of this substance. • Our understanding of the actions, effects and side effects of the newer drugs is increasing, aiding the most appropriate choice of drug in the individual patient. Further potentially exciting new medical therapies and therapeutic approaches are on the horizon,    6. Session 6: Antiproliferatives by Erik Greve • Our dosage and location of antiproliferative agents is wholly inaccurate. • MMC and 5-FU are still our practical solution for clinical practice. • Because of point 1 and side-effects, new developments/improvements on wound modulation are urgently needed. • These new antiproliferative drugs should preferably have the potency of MMC without the side-effects and be easy to apply quantitatively. • Alternatives may be found in several approaches (TGFß antisense oligonucleotide, TGF-ß2 monoclonal antibodies, taxol, photodynamic drugs), of which only TGFß monoclonal antibodies and BCACT-AM have been tested in humans. • The relative value of these alternatives compared to MMC are not yet known. • Bleb extension with use of antiproliferatives has not yet been adequately tested. • Trabecular meshwork morphology after erbium:YAG ablation does not give hope of clinical success. 7. Session 7: Surgery and NPFS by Alain Béchetoille • The full thickness EX-Press glaucoma implant works in the short-term when used in combined cataract and glaucoma surgery; conversely, combining aspiration of the trabeculum and phaco does not work as well as adding conventional trabeculectomy to phaco. • A large-sized scleral flap during trabeculectomy could induce a more diffuse bleb. • An amniotic membrane graft is less effective than conventional conjunctival advancement for repairing recalcitrant leaking blebs. • Argon laser peripheral iridoplasty is efficient in permanently reopening the anterior chamber angle of iridectomized eyes with iris plateau syndrome; dynamic gonioscopy is required to assess the condition before and after iridoplasty. • Monitoring IOP with an intracamera sensor during experimental deep sclerectomy in human eye-bank eyes shows that most outflow resistance vanishes when Schlemm's canal is opened and the external trabeculum removed. • Biomathematical models and ultrasonic biomicroscopy (UBM) help in understanding how nonpenetrating surgery of glaucoma works, including: uveoscleral pathway, transcorneo-trabecular window pathway to an intrascleral lake, and then Schlemm's canal or, more probably, trans-flap or peri-flap filtration to a diffuse conjunctival bleb. • The central Descemet's membrane of rabbits is almost impermeable to aqueous outflow. • The usefulness of implants for improving the success of deep sclerectomy is still controversial; work is in progress with reticulated hualuronic acid implants. 8. Session 8: Nonpenetrating filtering surgery by Roberto Carassa • Deep sclerectomy is effective in lowering IOP, as well as being safe. • Compared to trabeculectomy, nonpenetrating filtering surgery is less effective, but has less influence on lens changes. • The use of collagen implants in nonpenetrating filtering surgery may produce better results. • The use of viscoelastics in nonpenetrating filtering surgery is effective in lowering IOP, with final pressures being in the high teens. • There is an urgent need of randomized clinical trials to compare nonpenetrating filtering surgery with trabeculectomy.    results Selected results of the interactive question and answer system at the EGS 2000 meeting The interactive question and answer system was used extensively at the EGS 2000 meeting and provided interesting opinions from this large audience regarding the diagnosis and treatment of glaucoma. Genetics • Only 13% of participants used genetic testing in their clinical glaucoma routine • Some 70% of participants found a family history of glaucoma in 10-30% of their patients   Visual function and optic nerve imaging • 80% of participants used FDT, 70% used SWAP • 60% of participants routinely used optic nerve imaging • 52% of participants relied on both visual field and optic nerve imaging • 33% relied more on visual field than on optic nerve imaging, and 15% vice versa • 50% of participants used optic nerve head photos, 25% the Heidelberg retina tomograph, while less than 10% used various other methods each    Blood flow • 90% of participants believed that compromised blood flow plays a role in the pathogenesis of glaucoma, but less than half evaluated the vascular status • 80% of participants felt that drug effects on blood flow should be evaluated and also cared about drug effects on the circulation • 70% of participants would use a drug that improved the blood flow without any effect on IOP   Congenital glaucoma • Half the participants used MMC for filtering surgery in children   Pigmentary glaucoma • 20% of participants routinely performed peripheral iridotomy in pigmentary glaucoma   Medical treatment • 60% of participants felt that innovative treatment of glaucoma should be aimed at neuroprotection • 80% of participants only regarded studies on visual field progression in human glaucoma as convincing evidence of neuroprotection • 70% of the participants sometimes used a beta-blocker as their drug of first choice; 35% always used beta-blockers as their first choice; 20% used a prostaglandin analogue (PG) as their first choice; 54% used PG as their second choice; 40% sometimes used PG as their first choice • 75% had no experience with unoprostone, 25% no experience with brimonidine • half the participants added latanoprost to timolol, the other half switched • 75% of participants had seen adverse effects from medical treatment (of all types) in 10-40% of patients   Surgical treatment • 86% of participants performed trabeculectomy, 13% nonperforating filtering surgery. Most surgeons used nonperforating filtering surgery in eyes with low risk for failure. Poor results were the major reason for not using nonperforating filtering surgery • 86% of participants used antiproliferatives, 25% of these always, the other 75% only if there was a high risk of failure   award EGS awards At the gala dinner of the EGS 2000 meeting, awards were presented for the three best papers and three best posters. Recipients of the awards for the papers were: • M. Westcott, D.F. Garway-Heath, F.W. Fitzke, J. Tan and R.H. Hitchings: Correlating perimetric sensitivity with structure: the appropriate scaling of differential light sensitivity and the correlation with neuroretinal rim area in glaucoma. London, UK • D. Mackey, C.M. Green, M.M. Sale, J.E. Craig, J.L. Dickinson, D.H. Healey, S.H. Stanwix and P.J. McCartney: Familial aggregation of glaucoma experience with the glaucoma inheritance study in Tasmania (GIST). East Melbourne and Hobart, Australia • S. Gandolfi, L. Quaranta, L. Cimino and S. Bettelli: Deep sclerectomy without implants versus trabeculectomy with releasable sutures: a two-center prospective (24 months) randomized clinical trial. Parma and Brescia, Italy Recipients of the awards for the posters were: • B. Haargaard, P.K. Jensen, S.V. Kessing and O.I. Nissen: Exercise and iris bowing in healthy eyes. Copenhagen, Denmark • I. Lanzl and R.L. Merte: Does head positioning influence anterior chamber depth in pseudoexfoliation syndrome. Munich, Germany • T. Zarnowski, R. Rejdak, Z.F. Zagorski, A.G.M. Juenemann, T. Kocki and W.A. Turski WA: Detection and quantification of a potential neuroprotectant kynurenic acid in the vitreous body. Lublin, Poland   Issue 2-2 Table of Contents Editor's Selection Change Issue 24-424-324-1/223-423-323-223-122-422-322-222-121-421-321-221-120-420-320-220-119-419-319-219-118-418-318-218-117-417-317-217-116-416-316-216-115-415-315-215-114-414-314-214-113-413-313-213-112-412-312-212-111-411-311-211-110-410-310-210-19-49-39-29-18-48-38-28-17-37-27-16-36-26-15-35-25-14-34-24-13-33-23-12-32-22-11-31-21-1 advertisement