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Top-Five of the Latin American Glaucoma Society (SLAG) Meeting
Bogotá, Colombia, November 21-22, 2014

Sebastião Cronemberger

1. The assessment of retinal nerve fiber layer (RNFL) thickness and the stereometric parameters of the optic nerve head (ONH) are indispensable to establish the differential diagnosis between megalopapilla (pseudo glaucoma) and glaucoma. Two patients (mother, 31 years old and her daughter, three years old, who had had unnecessary antiglaucomatous treatment for two years) had the diagnosis of megalopapillae (the optic discs areas were equal to or larger than 3.37 mm2 in both patients by confocal scanning laser ophthalmoscopy (CSLO, HRTII). The complete ophthalmic examination, including the diurnal curve of IOP with the IOP measurement at 6:00 a.m. with Perkins tonometer with the patients in a supine position in bed and in darkness and before they had stood up, central corneal thickness measurement and the peripapillary RNFL thickness measurement using the spectral domain optical coherence tomograghy (Spectralis HRA + OCT) were normal. The mother’s standard automated perimetry was also normal. (Sebastião Cronemberger, Brazil)
2. Unlike classic trabeculectomy, the trabeculectomy with suprachoroidal derivation has the advantage of using two different drainage pathways to lower the IOP, the anterior chamber to subconjunctival space fistula and the uveoescleral drainage through the suprachoroidal space. This novel procedure achieved a statistically significant reduction of the intraocular pressure after 24 months of follow-up. It is an effective and safe surgical technique. (Rodolfo A. Perez Grossmann, Perú)
3. Laser iridotomy (guidelines)
   When? 1. Acute primary angle closure; 2. Contralateral eye; 3. Potential occludable angle (very narrow angle in at least two quadrants or 180o with less than 20o, Shaffer I-II); 4. Pigment dispersion syndrome: only in patients < 40 years old presenting a posterior iris convexity by UBM.
   How?
   Location: nasal or temporal superior quadrant to avoid prismatic effects and ghost images; Technique: one to five shots of 5-15 mJ. No repetition of shots in the same place. If a partial opening is seen, we must reduce the strength before the second shot; Complications: slight hemorrhage (up to 71.2% of patients); posterior synechiae (9.6%); iritis (6.4%); IOP increase (9.8%); cataract (16.7%) (LOCS III). (John Jairo Aristizabal, Colombia)
4. Ten normal volunteers were examined with the GDx in a two-day protocol under eight testing conditions (1% pilocarpine, 10% phenylephrine, 1% tropicamide, or no drops, with room lights on or off). The twelve GDx’s parameters were compared under the eight testing conditions, using two ways ANOVA for repeated measurements and Tukey HSD post hoc test. Ten of the twelve parameters were statistically significantly different (P < 0.05) when measured under the three medication or no medication conditions, controlling for the ambient light status. There were no significant differences when measured with the light on or off, controlling for use of drops. Nerve fiber layer measurements with the GDx were influenced by drugs affecting pupillary diameter, but not by the status of room light or ciliary muscle tone. (Augusto Paranhos, Brazil)
5. An Atlas of Glaucoma (Apple Story) was launched and the SLAG members discussed and approved the first Latin-American Consensus on primary angle-closure glaucoma.

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