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Top-Eleven of the 18th South African Glaucoma Conference
Zimbali-Kwazulu Natal, South Africa, May 29-31, 2015

Ellen Ancker

1. RF of developing glaucoma with a positive family is eight to ten-fold higher.
2. Thirteen percent of patients with OH develop glaucoma in seven years, not everyone with OH develops glaucoma.
3. The ’glaucoma Zone’ is 70 years and above due to increased vascular insufficiency, neuronal vulnerability. Evidence of mitochondrial dysfunction with glaucoma.
4. Even at normal IOP levels, the ON is probably under stress.
5. IOP is dynamic with many pressure spikes per hour.
6. It can take two to five years to detect RoP, 11 VFs over a two-year period are necessary to detect the trend.
7. Patient question: can I do anything else? Yes, diet increase in vegetables, obesity is associated with glaucoma, coffee is a RF above five cups, marijuana lowers IOP, exercise: a ten-km race lowers IOP by 37%. (Jonathan G. Crowston, Sydney, Australia)
8. ONH evaluation: do not miss NFL loss, haemorrhage, do not underestimate c/d ratio, 90% of temporal arteritis have got rim loss, glaucoma with triangular optic atrophy think of mitochondrial dysfunction.
9. Do not miss OSD with glaucoma patients, 60% have symptoms in one eye, 38% were on single medication, treat with antihistamine and lubricants.
10. Wound Healing: Needling with MMC: 42% need a redo, minimize conjunctivitis and inflammation with Acular and FML, MMC for all trabeculectomies, do not wait for IOP to rise before acting! When bleb needling: gonio prior! at slitlamp/OR. Determine site, well anaesthetized injection with 30/27 gauge needle, pass through tenon’s barrier, 5FU/ MMC/Avastin.
11. With PEX, do cataract extraction early to reduce IOP; with OH look for PEX. Medicinal cannabis is less effective than glaucoma drugs. Recognizing patterns of IOP circadian rhythms may better assist in choosing the most appropriate therapy. (Grant Mclaren, Johannesburg, SA)

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