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Top-nine Third Polish Glaucoma Symposium
October 10-12, 2002, Wroclaw, Poland
Hanna Nizankowska
The Third Polish Glaucoma Symposium was held in Wroclaw, Poland, in October 2002. Over 900 ophthalmologists attended the conference, which featured 61 free paper presentations and 15 scientific posters. The first day of the symposium was devoted to the pathogenesis of glaucoma neuropathy and new modalities for its medical treatment. The second day of the plenary sessions, which was completely devoted to glaucoma surgery and was called the Polish-German session, was prepared in cooperation with the German Society of Ophthalmology (DOG). It was a splendid forum for the exchange of experience and to study the outcomes of various surgical techniques.
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Vascular endothelium acts by releasing an array of biologically active mediators, such as nitric oxide, prostacyclin (PGI2), and many others. The question arises as to whether any drugs with experimentally or clinically documented potential to reverse systemic endothelial dysfunction will also prove efficient in the prevention and treatment of certain types of glaucoma.
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Carbonic anhydrase (CA) handling the vasodilators COČ and H+ is involved in local flow modulation in the retinal and ONH capillary endothelium. This finding is in favor of a blood-flow-increasing effect of the CA inhibitor, dorzolamide, in the posterior part of the eye.
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Carbonic anhydrase inhibitors affect optic nerve oxygen tension by means of a dual mechanism. Acetazolamide and dorzolamide directly elevate optic nerve oxygen tension, presumably by means of a vasodilatory effect, and indirectly, by means of lowering the intraocular pressure.
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Metipranol, a drug with a neuroprotective action that decreases the adverse influence of ischemia on the structure and function of the retina, inhibits calcium and sodium ions from entering the neural cells of the retina, and reduces of the amount of neurons, increases the blood flow in the ONH.
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Viscocanalostomy was defined as being inferior to trabeculectomy with respect to IOP lowering potency; however, trabeculectomy had a higher incidence of hypotensive complications. There was no significant difference between viscocanalostomy and deep sclerectomy combined with a hyaluronate implant (Skgel), with regard to IOP regulating potency.
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Transforming growth factor-b2 (TGF-b2) in the aqueous humor is a potent stimulator of scarring, and plays a crucial role in the inflammatory, proliferative, and remodelling stage of wound healing in glaucoma surgery. An increased concentration of active TGF-b2 in the aqueous humor appears to be a risk factor for postoperative bleb scarring, especially in patients with pseudoexfoliation previously treated with argon laser trabeculoplasty.
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Silicone oil can be used successfully as a vitreous substitute in the treatment of neovascular glaucoma and vitreous hemorrhage. The effects of silicone oil vitreous substitution are rapid regression of rubeosis iridis and prevention of the severe complications reported after vitreoretinal surgery for neovascular glaucoma, such as recurrent vitreous hemorrhage, extensive formation of fibrin, and retinal detachment.
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Baerveldt glaucoma implants are a valuable method for decreasing OP in refractory glaucoma. Ligation and temporary occlusion techniques prevent postoperative hypotony and minimize the risk of choroidal hemorrhage
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Baerveldt glaucoma implants could be preferred as the primary surgical treatment in eyes after chemical burns. Cyclocryotherapy performed before the implantation of drainage devices increases the risk of postoperative complications.
