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Impressions on the Gullstrand Meeting

Uppsala, Sweden, April 1st, 2000

Albert Alm

In the UK, the most common indication (almost 60%) for glaucoma surgery is failure to control intraocular pressure (IOP). One in three operations are due to progression of fields or disc and only 5% are primary surgery. The potential for endophthalmitis, not hypotony, is the major problem of fibroblast inhibitors. Antimetabolites will expose any defects in surgical techniques and should be combined with surgical refinement! Humanized recombinant antibodies to TGF-ß2 may become a physiological agent to prevent scarring. Successful trabeculectomy keeps the mean IOP about 4 mmHg lower than medication or laser treatment, and stabilizes the mean change in visual field scores for several years. Follow-up studies after glaucoma surgery shows a dose-response curve if visual field progression is plotted against the mean post-operative IOP. With successful surgery combined with fibroblast inhibitors, and postoperative interventions including medical treatment when necessary, the IOP can be reduced from the mid-twenties to 10-12 mmHg, and the mean MD of the visual fields remains stable for at least five years. In uveitic glaucoma, a single-plate Molteno implant has a high success rate, while larger plates may do better in other forms of complicated glaucoma. Early studies in monkeys showed that the openings to Schlemm's canal were closed by scar tissue in most eyes after one year. Both viscocanalostomy and deep sclerectomy have fewer complications than trabeculectomy, but a lower success rate, particularly if the aim is an IOP in the low teens.