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Top-Five South African Glaucoma Society Meeting sine et cum Joint Meeting Downstate New York State University and South African Glaucoma Society

July 2003, Drakensberg resp. June 2003, Cape Town, South Africa

Petrus Gous

• Mitomycin C can be applied to the scleral bed (under the scleral flap) in deep sclerectomy in an intermittent drop-like fashion and continuously swabbed away for the duration of application instead of being applied with a sponge, with similiar IOP control results but less local side effects.
• Implantation of the Xpress implant under a scleral flap increases its safety and efficacy.
• Xpress implant under scleral flap reduced IOP from mean 27.2 mmHg preop to mean 13.7 mmHg at 18 months postop.
• Ahmed valves can be successfully implanted using a scleral tunnel technique in stead of covering the tube with a graft.
• Prostaglandin analogues not indicated in pregnant women or women planning to start a family due to their smooth muscle contraction effect.
• Better IOP results after SLT if no post laser topical steroids are given.
• 50% of early glaucoma patients with normal white on white perimetry in second eye had abnormal multifocal objective perimetry, where multifocal VEP's are tested.
• Central corneal thickness less than 555 micron in ocular hypertension patients had 3 fold higher risk for glaucoma.
• Blacks with glaucoma do better with prostaglandin analogues and less well with Beta blockers than whites with glaucoma.
• Beware of unilateral prostaglandin analogues, due to the cosmetic asymmetrical effects e,g. lash length and colour.
• Alphagan is contraindicated in neonates, can be fatal.
• Topical Carbonic anhydrase inhibitor is best addition to initial prostaglandin analogue treatment for glaucoma.
• When deciding on medical versus surgical treatment, "friends don't let friends take 4 or 5 medicines."
• In ocular hypertension and glaucoma patients, 89% had more than 5 mmHg IOP drop after SLT as primary treatment.
• Any two risk factors combined of Tenonectomy, chronic blepharitis, diabetic neovascular glaucoma and use of intraoperative mitomycin C in Ahmed valve implants have almost 100% incidence of valve or tube erosion at long term follow up.