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1 General aspects (0)   1.1 Epidemiology (7)   1.2 Population genetics (2)   1.3 Pathogenesis (9)   1.4 Quality of life (6)   1.5 Glaucomas as cause of blindness (2)   1.6 Prevention and screening (2) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (3)   2.2 Cornea (9)   2.3 Sclera (0)   2.4 Anterior chamber angle (0)   2.5 Meshwork (0)     2.5.1 Trabecular meshwork (10)     2.5.2 Schlemms canal (1)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (0)     2.6.1 Production (0)     2.6.2 Outflow (5)       2.6.2.1 Trabecular meshwork (0)       2.6.2.2 Uveoscleral (0)     2.6.3 Compostion (1)   2.7 Episcleral veins and venous pressure (0)   2.8 Iris (1)   2.9 Ciliary body (1)   2.10 Lens (0)   2.11 Vitreous body (0)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (0)   2.13 Retina and retinal nerve fibre layer (12)   2.14 Optic disc (23)   2.15 Optic nerve (1)   2.16 Chiasma and retrochiasmal central nervous system (0)   2.17 Stem cells (0)   2.20 Other (0) 3 Laboratory methods (1)   3.1 Microscopy (3)   3.2 Electron microscopy (1)   3.3 Immunohistochemistry (10)   3.4 Molecular genetics (0)     3.4.1 Linkage studies (16)     3.4.2 Gene studies (1)   3.5 Molecular biology incl. SiRNA (15)   3.6 Cellular biology (2)   3.7 Biochemistry (3)   3.8 Pharmacology (6)   3.9 Pathophysiology (1)   3.10 Immunobiology (0)   3.11 Pharmacogenetics (0)   3.12 Proteomics (0)   3.13 In vivo imaging (0)     3.13.1 Laser Scanning (0)       3.13.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       3.13.1.2 Confocal Scanning Laser Polarimetry (0)     3.13.2 Optical Coherence Tomography (0)       3.13.2.1 Anterior Segment (0)       3.13.2.2 Posterior Segment (0)     3.13.3 RGC Imaging (0)     3.13.4 Other (0)   3.20 Other (1) 4 Tissue culture of ocular cells (0) 5 Experimental glaucoma; animal models (29)   5.1 Rodent (0)   5.2 Primates (0)   5.3 Other (0) 6 Clinical examination methods (0)   6.1 Intraocular pressure measurement; factors affecting IOP (19)     6.1.1 Devices, techniques (0)     6.1.2 Fluctuation, circadian rhythms (0)     6.1.3 Factors affecting IOP (0)   6.2 Tonography, aqueous flow measurement (see also 2.6) (0)   6.3 Biomicroscopy (slitlamp) (0)     6.3.1 Anterior segment (2)     6.3.2 Posterior segment (0)   6.4 Gonioscopy (0)   6.5 Ophthalmoscopy (0)   6.6 Visual field examination and other visual function tests (1)     6.6.1 Conventional manual (0)     6.6.2 Automated (13)     6.6.3 Special methods (e.g. color, contrast, SWAP etc.) (12)   6.7 Electro-ophthalmodiagnosis (8)   6.8 Photography (0)     6.8.1 Anterior segment (0)     6.8.2 Posterior segment (6)   6.9 Computerized image analysis (3)     6.9.1 Laser scanning (25)       6.9.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       6.9.1.2 Confocal Scanning Laser Polarimetry (0)     6.9.2 Optical coherence tomography (20)       6.9.2.1 Anterior (0)       6.9.2.2 Posterior (0)     6.9.5 Other (2)   6.10 Fluorescein (ICG) angiography (0)     6.10.1 Anterior segment (0)     6.10.2 Posterior segment (0)   6.11 Bloodflow measurements (12)   6.12 Ultrasonography and ultrasound biomicroscopy (3)   6.13 Provocative tests (3)   6.19 Telemedicine (0)   6.20 Progression (3)   6.30 Other (7) 8 Refractive errors in relation to glaucoma (0)   8.1 Myopia (0)   8.2 Hypermetropia (0)   8.3 Contact lenses (0)   8.4 Refractive surgical procedures (3)   8.5 Other (0) 9 Clinical forms of glaucomas (0)   9.1 Developmental glaucomas (1)     9.1.1 Congenital glaucoma, Buphthalmos (0)     9.1.2 Juvenile glaucoma (2)     9.1.3 Syndromes of Axenfeld, Rieger, Peters, aniridia (3)     9.1.4 Other (1)   9.2 Primary open angle glaucomas (0)     9.2.1 Ocular hypertension (5)     9.2.2 Other risk factors for glaucoma (5)     9.2.3 Open angle glaucoma with elevated IOP (0)     9.2.4 Normal pressure glaucoma (7)   9.3 Primary angle closure glaucomas (6)     9.3.1 Acute primary angle closure glaucoma (pupillary block) (5)     9.3.2 Chronic primary angle closure glaucoma (pupillary block) (0)     9.3.3 Plateau iris syndrome (0)     9.3.4 Primary angle closure suspect (0)     9.3.5 Primary angle closure (0)     9.3.10 Other (0)   9.4 Glaucomas associated with other ocular and systemic disorders (0)     9.4.1 Steroid-induced glaucoma (3)     9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (0)       9.4.2.1 Iridocorneal endothelial syndrome (ICE, incl. irisatrophy) (1)       9.4.2.2 Posterior polymorphous dystrophy (0)       9.4.2.3 Fuchs' endothelial dystrophy (0)       9.4.2.5 Other (0)     9.4.3 Glaucomas associated with disorders of the iris and ciliary body (0)       9.4.3.1 Pigmentary glaucoma (0)       9.4.3.5 Other (0)     9.4.4 Glaucomas associated with disorders of the lens (1)       9.4.4.1 Exfoliation syndrome (9)       9.4.4.2 Glaucomas associated with cataracts (1)       9.4.4.3 Glaucomas associated with lens dislocation (0)       9.4.4.5 Other (0)     9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous (0)       9.4.5.1 Neovascular glaucoma (4)       9.4.5.5 Other (0)     9.4.6 Glaucomas associated with inflammation, uveitis (5)     9.4.7 Glaucomas associated with ocular trauma (3)     9.4.8 Glaucomas associated with intraocular tumors (1)     9.4.9 Glaucomas associated with elevated episcleral venous pressure (0)       9.4.10 Glaucomas associated with hemorrhage (0)     9.4.11 Glaucomas following intraocular surgery (0)       9.4.11.1 Ciliary block (malignant) glaucoma (1)       9.4.11.2 Glaucomas in aphakia and pseudophakia (1)       9.4.11.3 Epithelial, fibrous, and endothelial proliferation (0)       9.4.11.4 Glaucomas associated with corneal surgery (0)       9.4.11.5 Glaucomas associated with vitreoretinal surgery (2)     9.4.15 Glaucoma in relation to systemic disease (3)     9.4.20 Other (0) 10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy (5) 11 Medical treatment (0)   11.1 General management, indication (11)   11.2 Cholinergic drugs (0)   11.3 Adrenergic drugs (0)     11.3.1 Epinephrine (0)     11.3.2 Thymoxamine, dapiprazole (0)     11.3.3 Apraclonidine, brimonidine (6)     11.3.4 Betablocker (12)     11.3.5 Other (0)   11.4 Prostaglandins (17)   11.5 Carbonic anhydrase inhibitors (0)     11.5.1 Systemic (0)     11.5.2 Topical (4)   11.6 Osmotic treatment (2)   11.7 Treatment of bloodflow (1)   11.8 Neuroprotection (11)   11.9 Gene therapy (2)   11.13 Combination therapy (0)     11.13.1 Betablocker and pilocarpine (0)     11.13.2 Betablocker and carbon anhydrase inhibitor (0)     11.13.3 Betablocker and brimonidine (0)     11.13.4 Betablocker and prostaglandin (0)     11.13.5 Other (0)   11.14 Investigational drugs; pharmacological experiments (7)   11.15 Other drugs in relation to glaucoma (1)   11.16 Vehicles, delivery systems, pharmacokinetics, formulation (2)   11.17 Cooperation with medical therapy e.g. persistency, compliance, adherence (2)   11.20 Other (0) 12 Surgical treatment (0)   12.1 General management, indication (1)   12.2 Laser iridotomy (4)   12.3 Laser iridoplasty (2)   12.4 Laser trabeculoplasty and other laser treatment of the angle (5)   12.7 Surgical iridectomy (0)   12.8 Filtering surgery (0)     12.8.1 Without tube implant (8)     12.8.2 With tube implant or other drainage devices (14)     12.8.3 Non-perforating (12)     12.8.4 Using laser (0)     12.8.5 Other (0)     12.8.10 Woundhealing antifibrosis (10)     12.8.11 Complications, endophthalmitis (7)   12.9 Trabeculotomy, goniotomy (1)   12.10 Cyclodestruction (2)   12.11 Cyclodialysis (0)   12.12 Cataract extraction (0)     12.12.1 Intracapsular (0)     12.12.2 Extracapsular (1)     12.12.3 Phacoemulsification (13)   12.14 Combined cataract extraction and glaucoma surgery (0)     12.14.1 Intracapsular (0)     12.14.2 Extracapsular (0)     12.14.3 Phacoemulsification (6)   12.15 Capsulotomy (0)   12.16 Vitrectomy (1)   12.17 Anesthesia (2)   12.20 Other (1) 13 Therapeutic prognosis and outcome (0)   13.1 Prognostic factors (0)   13.2 Outcome (0)     13.2.1 IOP (0)     13.2.2 Visual field (0)       13.2.2.1 Progression (0)       13.2.2.2 Improvement (0)     13.2.3 Other (0) 14 Costing studies; pharmacoeconomics (1) 15 Miscellaneous (6)

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Abstract #12652 Published in IGR 7-3

Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: A case series

Tesser R; Hess DB; Freedman SF
Journal of AAPOS 2005; 9: 330-335

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PURPOSE: We sought to investigate the outcomes of children who underwent simultaneous intraocular lens (IOL) implant and glaucoma implant surgery. METHODS: Medical records of all patients who underwent simultaneous IOL implant and glaucoma implant surgery from January 1995 through August 2003 by a single surgeon were reviewed. Criteria for success included intraocular pressure ≤22 mmHg, or judged adequate for glaucoma severity, without vision loss or devastating complication. RESULTS: The study included 9 eyes of 8 children who had a mean age of 7.6 years (range, 1-16) and a mean follow-up time of 21 months (range, 8.5-35 months) after simultaneous IOL (either cataract removal with primary IOL, 2 eyes; or secondary IOL implantation, 7 eyes), and glaucoma implant surgery (6 Baerveldt, 3 Ahmed). The indications for combined surgery fell into 3 basic categories: unilateral aphakia with glaucoma (4/9), anatomical features (such as shallow anterior chamber and/or vitreous in the pupillary plane) making an IOL helpful in positioning the tube away from corneal endothelium and/or vitreous (4/9), and unilateral traumatic cataract (1/9). Mean intraocular pressure for operated eyes was 29 mmHg (range, 21-44) preoperatively and fell to 17 mmHg (range, 11-22) at last follow up, P = 0.01. The mean number of glaucoma medications was 3.5 preoperatively (range, 2-5) versus 1.9 (range, 0-4) at last follow-up (p = NS). Complications (n = 5) were varied, only 2 of which required additional surgery. Eighty-nine percent (8/9) of patients met criteria for success at last follow-up. CONCLUSIONS: Selected children can do well after combined glaucoma implant and IOL surgery, achieving both satisfactory glaucoma control and stable visual acuity.

Dr. S.F. Freedman, Duke University Eye Center, Box 3802, Durham, NC 27710, USA

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Classification:

12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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