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Top-ten of the Pan American Glaucoma Society (PAGS)
May 30, 2007, Cancún, Mexico
Javier Casiraghi and Daniel Grigera
The Glaucoma Subspecialty day, organized by The Pan American Glaucoma Society, was held on May 30, 2007 at the Hotel Fiesta Americana Gran Cancún, in Cancún, Mexico. The activity was part of the 27th Pan-American Congress of Ophthalmology.
Special guests were Drs. Robert N. Weinreb, Roberto Sampaolesi and Paul Palmberg, who together with other PAGS members from all over America covered five hours of scientific sessions.
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Even though IOP lowering is currently the only approved therapy for glaucoma, many patients continue to experience progressive vision loss. Why is it so difficult to prove glaucoma neuroprotection? Since glaucomatous optic neuropathy is a slowly progressive disease, the duration of clinical trials on neuroprotection is necessarily much longer, and the number of patients enrolled is much larger than those required for determining IOP-lowering. Moreover, progression detection and defining the study endpoints are difficult tasks. (R. Weinreb, La Jolla)
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Arg480Lys, a new MYOC mutation for primary open-angle glaucoma has been reported in an Andean Peruvian family. (R. Pérez-Grossman, Lima)
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The presence of dry eye should be suspected in every patient being administered glaucoma therapy. Specific measures concerning the glaucoma therapy should be applied to diagnosed patients according to the various levels of the Lacrimal Dysfunction Syndrome� as defined by a Wilmer Expert Consensus. (D. Grigera, Buenos Aires)
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A four-millimeter tunnelization of the deep scleral wall into the anterior chamber using a conveniently angulated needle allows to introduce the Ahmed Glaucoma Valve tube. This procedure, which avoids the use of a scleral or pericardium patch, as well as having to dissect a scleral flap, has a low incidence of tube exposure. (F. Gil-Carrasco, Mexico City)
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A novel and simple method for shortening an excessively long tube without having to revise the site of surgery or taking it out from the anterior chamber, involves cannulating the tube with a 30-Gauge needle introduced through the cornea and then introducing a Vannas scissors through a parallel incision. The cannulated portion of the tube is approached to the scissors and, after being cut, is removed with a thin forceps. (J. Jiménez-Román, Mexico City)
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The Roussell-Frankhauser goniolens is optimal for goniophotography and for video imaging of the angle, and provides a high quality of image and magnification. (R. Sampaolesi, Buenos Aires)
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Sleep apnea, as a risk factor for worsening in glaucoma, must be carefully investigated in normal tension glaucoma suspects. (C. Hartleben, Mexico City)
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Including the use of the Ocular Response Analyzer in a systematic glaucoma examination significantly decreased diagnostic inaccuracy due to central corneal thickness. (G. Velazco Gallegos, Mexico City)
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Both the water drinking test and the ibopamine test have their place in glaucoma diagnosis. The clinical usefulness of the water drinking test for the study of IOP variability in glaucoma patients has already been demonstrated. The ibopamine test, on the other hand, helps differentiate between eyes with normal trabecular function and eyes with increased resistance. (J. Sampaolesi, Buenos Aires)
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Glaucoma filtering bleb dysesthesia caused by oversized blebs may easily be solved in many cases by cutting with scissors the tissue that overhangs from the limbus. Strange as it seems, there is scarce leak, if any, after the procedure. (P. Palmberg, Miami)
