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Developments in Ophthalmology

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https://www.readbyqxmd.com/read/28442697/when-should-we-give-up-filtration-surgery-indications-techniques-and-results-of-cyclodestruction
#1
REVIEW
Marisse Masis Solano, Guofu Huang, Shan C Lin
PURPOSE: Cyclodestructive procedures are traditionally used in cases of glaucoma that are refractory to medical and surgical therapy. The goal of this chapter is to describe the indications, contraindications, techniques, and pitfalls of cyclodestructive procedures, including transscleral cyclophotocoagulation (TCP), micropulse TCP (MP-TCP), endoscopic cyclophotocoagulation (ECP), and ultrasound cilioplasty. METHODS: A literature search for cyclodestructive techniques was performed, and relevant studies were included for evaluation and review...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442696/surgical-management-of-pediatric-glaucoma
#2
REVIEW
Ingrid Chang, Joseph Caprioli, Yvonne Ou
Pediatric glaucoma surgery is challenging because of the differences in anatomy from the adult, differences in the behavior of the tissues of a child's glaucomatous eye, the variety in causes of the disease, and difficulties with postoperative management. Goniotomy and trabeculotomy are the preferred initial treatments for primary congenital glaucoma. Trabeculectomy with adjunctive mitomycin C is more likely to succeed in older, phakic patients, but carries the long-term risk of bleb-associated endophthalmitis...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442695/management-of-concomitant-cataract-and-glaucoma
#3
REVIEW
Giorgio Marchini, Piero Ceruti, Gabriele Vizzari, Davide Berzaghi, Andrea Zampieri
The coexistence of cataract and glaucoma represents a challenge for the ophthalmologist and the issue is still open to debate. The surgical management is based on both the visual field defect and the loss of visual acuity. The surgical options currently available are: (1) cataract extraction alone, (2) sequential glaucoma surgery and cataract extraction, and (3) combined surgery by 1 site or by 2 separate sites. Phacoemulsification alone is suggested when glaucoma can be controlled by medication and the visual field defect is moderate and nonprogressive...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442694/surgical-treatment-of-angle-closure-glaucoma
#4
REVIEW
Dawn Lim, Maria Cecilia Aquino, Paul Chew
Advances in anterior segment imaging modalities have contributed new insights towards a better understanding of the various mechanisms of angle-closure glaucoma (ACG). This development is key to good decision making when confronted with angle-closure patients needing appropriate therapy. Surgical management of ACG remains an integral part of glaucoma patient care. The distinctive anatomy of angle-closure eyes and the few objective lines of evidence to support the effectiveness of the different surgical treatment options present a challenge to glaucoma surgeons...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442693/ab-interno-schlemm-s-canal-surgery
#5
REVIEW
Brian A Francis, Handan Akil, Benjamin B Bert
In primary open-angle glaucoma, the site of greatest resistance to aqueous outflow is thought to be the trabecular meshwork (TM) and inner wall of Schlemm's canal. Augmentation of the conventional (trabecular) outflow pathway can facilitate physiologic outflow and subsequently lower intraocular pressure. The most recent approach to enhancing the conventional outflow pathway is via an internal approach to the TM and Schlemm's canal. Ab interno Schlemm's canal surgery includes 4 novel surgical approaches: (1) removal of the TM and inner wall of Schlemm's canal by an internal approach (ab interno trabeculectomy), (2) implantation of a microstent to bypass the TM, (3) disruption of the TM and inner wall of Schlemm's canal via an internal approach (ab interno trabeculotomy), and (4) dilation of Schlemm's canal via an internal approach (ab interno canaloplasty)...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442692/viscocanalostomy-and-canaloplasty-ab-externo-schlemm-s-canal-surgery
#6
REVIEW
Matthias C Grieshaber
Ab externo Schlemm's canal (SC) surgery (e.g., viscocanalostomy and canaloplasty) is a valuable alternative to glaucoma filtration surgery. It targets the abnormally high resistance to outflow in the trabecular meshwork (TM) and reestablishes the physiologic outflow system. In viscocanalostomy, viscoelastic substance is injected to dilate SC, which in turn leads to microdisruptions of the inner wall. In canaloplasty, the additional intracanalicular stent (suture or Stegmann Canal Expander®) keeps the canal patent and enhances the circumferential flow...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442691/laser-assisted-techniques-for-penetrating-and-nonpenetrating-glaucoma-surgery
#7
REVIEW
Noa Geffen, Ehud I Assia, Shlomo Melamed
The use of lasers is slowly pervading all subspecialties of ophthalmology, especially glaucoma, and lasers are slowly replacing many glaucoma surgeries. Conventional trabeculectomy has so far remained the gold standard for glaucoma surgery and efforts are being made to develop a new surgical approach to overcome the limited success rate and safety issues of this traditional procedure. There is a great interest in using lasers for ab interno and ab externo penetrating and nonpenetrating filtering surgery. Theoretically, laser-assisted surgery offers the potential advantage of improved accuracy, repeatability, and safety, although the main drawback of using lasers for this purpose is the potential collateral damage induced by the scattered energy...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442690/mini-drainage-devices-for-anterior-and-intermediate-filtration
#8
REVIEW
Marco Nardi, Chiara Posarelli, Francesco Nasini, Michele Figus
Mini glaucoma devices for external filtration may be implanted with an ab externo procedure (Ex-PRESS and InnFocus Microshunt) or with an ab interno procedure (XEN Gel stent). The Ex-PRESS is an FDA-approved mini glaucoma device that has been developed in order to simplify anterior guarded filtering procedures, making them faster, safer and easier. It is positioned under a scleral flap and it is introduced in the anterior chamber through a needle hole, avoiding the excision of the corneal-scleral button and the iridectomy...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442689/wound-healing-and-glaucoma-surgery-modulating-the-scarring-process-with-conventional-antimetabolites-and-new-molecules
#9
REVIEW
Gábor Holló
Subconjunctival absorption of aqueous humor is an essential part of glaucoma filtration surgery. Mitomycin C (MMC) and 5-fluorouracil have been used to reduce postoperative episcleral fibrosis and scar formation in the filtering bleb area for more than 2 decades. Both antimetabolites have also been frequently injected before needling revision of failing filtering blebs. Recently, MMC was also tried in tube surgery and nonpenetrating filtering surgery, but its usefulness in these applications has not yet been determined...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442688/ocular-surface-and-external-filtration-surgery-mutual-relationships
#10
REVIEW
Christophe Baudouin
There is a large body of evidence from clinical and experimental studies indicating that the long-term use of topical drugs may induce ocular surface changes, causing ocular discomfort, dry eye, conjunctival inflammation, subconjunctival fibrosis, corneal surface impairment, and, as a consequence of chronic ocular surface changes, the potential risk of failure for further glaucoma surgery. Subclinical inflammation has also been widely described in patients receiving antiglaucoma treatments for long periods of time, with inflammatory cell infiltration and fibroblast activation in the conjunctiva and subconjunctival space...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442687/postoperative-management-of-penetrating-and-nonpenetrating-external-filtering-procedures
#11
REVIEW
Paolo Bettin, Federico Di Matteo
Correct postoperative management is fundamental to prevent and treat complications and to optimize the success of filtering surgery. Timely control visits and appropriate actions and prescriptions ensure the best outcomes, allow recovery from a number of untoward events, and can reestablish filtration when failure seems imminent. In contrast, a slack follow-up and wrong interventions or prescriptions can lead to the failure of any surgery, no matter how accurately it was carried out, sometimes jeopardizing vision and even the anatomy of the globe...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442686/glaucoma-drainage-implant-surgery
#12
REVIEW
Ahmad A Aref, Steven J Gedde, Donald L Budenz
Glaucoma drainage implant (GDI) surgery represents a significant advance in the treatment of refractory glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of implant are currently available and differ in surface area, shape, composition, and the presence or absence of a flow-restricting valve. Two separate prospective, randomized clinical trials comparing 2 types of GDI have reported results after 5 years of follow-up...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442685/deep-sclerectomy
#13
REVIEW
Sylvain Roy, André Mermoud
Filtering surgery evolved from the classic trabeculectomy, in which penetration into the anterior chamber is a necessary step, toward nonpenetrating deep sclerectomy. The first procedure presents several serious complications, such as durable hypotony, hyphema, flat anterior chamber, choroidal detachment, endophthalmitis, and surgery-induced cataract. To avoid such drawbacks, a novel nonpenetrating technique was designed to improve the predictability of the intraocular pressure (IOP)-lowering action, while reducing the incidence of the immediate postoperative complications encountered with the penetrating method...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442684/enhanced-trabeculectomy-the-moorfields-safer-surgery-system
#14
REVIEW
Peng Tee Khaw, Mark Chiang, Peter Shah, Freda Sii, Alastair Lockwood, Ashkan Khalili
Trabeculectomy with antifibrotic treatment is still the most popular incisional procedure for glaucoma filtration surgery (GFS) worldwide. The advent of antifibrotic agents reduced failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimise the risk of: (1) complications and (2) surgical failure. This chapter covers preoperative, intraoperative, and postoperative strategies, which improve the outcome of GFS. Strategies to reduce the risk of complications centre on the prevention of postoperative hypotony by minimising the risk of overdrainage, postoperative wound leaks, and poor bleb morphology...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28442683/achievements-and-limits-of-current-medical-therapy-of-glaucoma
#15
REVIEW
Pelagia Kalouda, Christina Keskini, Eleftherios Anastasopoulos, Fotis Topouzis
Prescribing medical therapy for the treatment of glaucoma can be a complex process since many parameters should be taken into consideration regarding its achievements and limits. Today, a variety of options, including multiple drug classes and multiple agents within classes, are available to the clinician, but caution should be given to their side effects and contraindications. Glaucoma patients with preexisting ocular surface disease should be treated with caution, and preferably with preservative-free formulations, as there is an increased risk for symptom deterioration...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427076/application-of-clinical-trial-results-to-clinical-practice
#16
REVIEW
Marco A Zarbin, Neelakshi Bhagat, Lekha K Mukkamala
Two critical questions one must answer as one applies the results of a clinical trial to clinical practice are: (1) Regardless of whether the trial result is likely to be replicated or reproduced in a second large-scale trial, are the results likely to be reproduced in one's practice? (2) Regardless of whether the experimental treatment was better than the alternative on average for a population of patients, are the results clinically important for a given patient in one's practice? To determine if a study result is likely to be reproduced in one's clinical practice, it may be helpful to answer 5 questions: (1) Have steps been taken to minimize bias? (2) Is the result likely due to the treatment? (3) Is the result unlikely due to chance? (4) Is the study population representative of one's patients? (5) Is the totality of evidence consistent? If the answer to all 5 questions is "yes," then we posit that the trial result is likely to be reproduced in one's practice...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427075/diabetic-macular-edema-emerging-strategies-and-treatment-algorithms
#17
REVIEW
Elad Moisseiev, Anat Loewenstein
Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients, and its management is often a long process requiring frequent monitoring and therapeutic interventions. During the past several decades, numerous treatments have been developed for the treatment of DME. Although many of them have been found to be effective and safe, there is relatively little comparative data, and no established guidelines for the optimal treatment approach exist. In this chapter, the evolution of DME therapies is reviewed, and the current common practice patterns are discussed...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427074/enzymatic-vitreolysis-for-vitreomacular-traction-in-diabetic-retinopathy
#18
REVIEW
Stanislao Rizzo, Daniela Bacherini
Vitreomacular traction (VMT) is one of many possible factors involved in the etiology of diabetic macular edema (DME). Pharmacologic vitreoretinal separation is a potential alternative to vitrectomy for VMT in diabetic retinopathy. Small case series have been published on the use of enzymatic vitreolysis in tractional DME, and demonstrate that the enzymatic release of the posterior vitreous cortex is more likely following the injection of plasmin enzyme. Further prospective and randomized clinical trials are necessary to evaluate the clinical relevance of ocriplasmin for vitreomacular traction in diabetic retinopathy, and additional studies are needed to determine more accurately which patients might benefit most from this treatment and how often and at what concentration ocriplasmin should be administered...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427073/surgical-management-and-techniques
#19
REVIEW
Marco Codenotti, Lorenzo Iuliano, Gisella Maestranzi
Technical advancements have substantially extended the indications for surgery in diabetic retinopathy (DR) during the last 40 years, from the traditional indications including non-clearing vitreous hemorrhage, traction retinal detachment (RD), and traction-rhegmatogenous RD, to epiretinal membrane (ERM), vitreomacular traction, diffuse macular edema, neovascular glaucoma, and anterior hyaloid fibrovascular proliferation. The goals of vitreoretinal surgery in DR are multiple: clearing media opacities, release of traction (anteroposterior and/or tangential), segmentation and/or removal of traction bands, peeling of ERMs, hemostasis, laser photocoagulation, and tamponade of retinal breaks with gas or silicone oil...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427072/anti-vascular-endothelial-growth-factor-injections-the-new-standard-of-care-in-proliferative-diabetic-retinopathy
#20
REVIEW
Xintong Li, Marco A Zarbin, Neelakshi Bhagat
For decades, panretinal photocoagulation (PRP) has been the standard of care for the treatment of proliferative diabetic retinopathy (PDR). The relatively recent advent of anti-vascular endothelial growth factor (VEGF) formulations for intravitreal injection has provided a fresh perspective on PDR treatment, especially in eyes with concurrent diabetic macular edema (DME). The anti-VEGF agent ranibizumab has demonstrated a potentially protective effect on eyes with DME in terms of progression to PDR in the RIDE/RISE trials, as has aflibercept in the VIVID/VISTA trials...
2017: Developments in Ophthalmology
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