advertisement
Top-three of the South African Glaucoma Society Meeting
Drakensberg, South-Africa, August 15 -17, 2008
Ellen Ancker
- The one-year results of the Tube versus Trabeculectomy Study (TVT) tells us that non-valved tube shunt surgery was more likely to maintain IOP control and avoid persistent hypotony and re-operation for glaucoma than trabeculectomy with MMC during the first year followup. Tube shunt surgery and trabeculectomy with MMC produced similar IOP reduction at one year. There was less need for supplemental medical therapy with trabeculectomy. The incidence of post-operative complications was higher following trabeculectomy with MMC than non-valved tube shunt surgery. Longer follow-up is forthcoming. (Paul Palmberg, Miami, USA)
- A 30-gauge needle is very useful to manage glaucoma problems at the slitlamp in the clinic. For example, when a patient presents with a steamy cornea from an acute angle-closure glaucoma attack, one can rapidly and safely lower the IOP and clear the cornea with a 30-gauge needle paracentesis. After applying anaesthetic, Betadine solution and rinsing, a 30-gauge needle held by the hub is passed into the inferior temporal cornea (a little steeper than iris plane parallel, and aimed toward 6 o'clock and on just into the anterior chamber. After five seconds, at which point flow through a half-inch 30-gauge needle stops, the needle is withdrawn. The IOP will be 12 ± 2 mmHg and the cornea will be clearer, enabling laser iridectomy. The 30-gauge needle can also be used to needle filtering blebs, cut pupil membranes, pull iris free from trabeculectomy ostia or drainage device tubes, and even to perform goniosynechiolysis or to rotate IOLs back into the bag. (Paul Palmberg, Miami,USA)
- Most painful filtering blebs can be made comfortable by simple procedures that modify the bleb and do not risk losing bleb function. A high bleb producing a dellen or bubble dysesthesia can be compressed and remolded to a lower, comfortable shape in two or three weeks by temporary placement of two or more 9.0 nylon mattress sutures, anchored in the peripheral cornea in front and in deep Tenon's capsule behind. The portion of a bleb overhanging the limbus can be lifted with a flat spatula and then cut off at the limbus with Vannas scissors. Remarkably, the remaining bleb does not collapse or leak! A circumferential filtering bleb interferes with tear flow. The unwanted portion of such blebs (to the sides and below) can be collapsed by puncturing with multiple cautery applications and then using a cotton tip applicator to roll the fluid in the tenon's capsule (which is like a sponge) to the puncture sites. (Paul Palmberg, Miami, USA)
