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Top-Ten of the Second International Congress on Glaucoma Surgery
February 6th-7th, 2003, Luxor, Egypt
Tarek Shaarawy
- Electron microscopical examination of rhesus monkey eyes that had undergone viscocanalostomy shows multiple breaks in the inner wall of Schlemm's canal and traces of remaining viscoelastic material close to the operations site, as well as 180° from the surgical site, four weeks postoperatively (Tamm et al.)
- Compared to drugs, surgery has the potential to fulfil many features of an ideal approach for treating IOP: can lower IOP to the low teens, achieve long-term IOP reduction, minimize IOP fluctuation, low costs, has minimal systemic side-effects except for ocular ones; but the use of surgery as first line treatment for IOP is limited by the high incidence of potential ocular complications. There is a serious need for improving surgical procedures in order to reduce ocular complications related to glaucoma surgery (Haefliger et al.).
- A four-year analysis of a randomized controlled trial comparing the results of deep sclerectomy without an implant to trabeculectomy, concludes that, if goniopuncture after deep sclerectomy is not considered a failure criterion, the success rate of the two procedures is comparable, even if 15 mmHg was used as the cut off IOP level of success. Deep sclerectomy was associated with lower perturbation of lens nuclear transparency and with a lower incidence of 'need-for' cataract extraction (Gandolfi et al.).
- Mitomycin eye drops after trabeculectomy in rabbit eyes seems to produce a similar effect as the subconjunctival injection of mitomycin on fibroblasts and collagen fibers, with no toxic effects on the conjunctival epithelium, as demonstrated by electron microscopy (Abolnasr et al.).
- On the first postoperative day, IOP can be used as a prognostic indicator in non-penetrating glaucoma surgery. Patients with IOP <= 5 mmHg are significantly less likely to require goniopuncture. Significant improvement was found in those with an initial IOP <= 5 in terms of time to failure.
- A randomized control trial comparing deep sclerectomy with and without mitomycin concluded that augmentation of deep sclerectomy with mitomycin C appears to increase the probability of maintaining a lower IOP, with no additional side-effects after one year of follow-up (Mielke et al.). o Interesting preliminary results with intrastromal diathermal keratostomy 11 months after treatment (range, 7-15 months): complete success in all eyes (mean IOP: 11 mmHg; range: 6- 15 mmHg), avoiding the iris incarceration commonly seen after subconjunctival sclerostomy (Kessing et al.)
- In juvenile rheumatoid arthritis (JRA), 10% of children develop chronic anterior uveitis. The iof secondary glaucoma in these children ranges from 14-27%. Molteno tube shunt surgery is the first choice of treatment in children with endogenous uveitis secondary to JRA (Airaksinen & Valimaki).
- Electrosurgical goniectomy is able to remove a full thickness central strip of the trabecular meshwork overlying Schlemm's canal with minimal collateral thermal damage (Baerveldt et al.).
- The Ex-PRESS implant is an efficient method for lowering IOP in combined surgery and is not associated with significant complications; the speed of the implantation (three minutes) makes combined surgery possible in some difficult cases. Optimal positioning of the device during surgery is mandatory in order to avoid conjunctival erosion (Schnyder & Mermoud).
