my seminar on surgical management of glaucoma

1. SURGICAL MANAGEMENT OF GLAUCOMA Abinaya.k.a Roll no:1

2. Surgical management Laser surgeries Trabeculotomy and goniotomy Penetrating filtering surgeries-trabeculectomy Non penetrating filtering surgeries Cyclo destructive procedures Artificial drainage implants

3. LASER SURGERIES Trabeculoplasty Peripheral iridotomy-Nd:Yag laser Cyclo ablation-diode laser LASER filtration procedures Argon laser selective laser

5. Elderly

6. Type of glaucoma-open angle

7. Pigmentation-pseudo exfoliation type;-pigmentary

8. Pre-operatively: The eye should be free from inflammation Iop should not be too high It should not be end stage glaucoma

9. ARGON LASER TRABECULOPLASTY Involves application of laser burns to the trabeculum at blue-green wavelengths It enhances aqueous flow Alt is ineffective in pediatric glaucoma and most of sec glaucoma except pigmentary and pseudo exfoliatory types

10. Application of laser beam:at the junction of pigmented and non pigmented trabeculum. Ideal reaction:minute gas bubble or blanching

11. Mechanism of action Mechanical effect: Tightening of TM Opening of intervening spaces Opening of collapsed schlemm’s canal Biological response: Release of cytokines-signals the macrophages to clear material that has accumulated in meshwork

12. procedure Pre-op:brimonidine eye drops 15 mins before Local anaesthetic Gonioscopic contact lens to visualise the angle 180 or 360 treated per session Post-op:glaucoma eye drops,anti-glaucoma medication ot be continued,short course of topical steroids Follow up-6 wks later

14. Small hemorrhages

15. Elevation of IOP

16. uveitis

17. Adverse effect on subsequent filtering surgery

19. peripheral iridotomy Definition: -creating a full thickness hole in the peripheral iris in order to alleviate the pupillary block.

21. Fellow eye of a patient with acute glaucoma

22. Narrow occludable angles

23. Secondary angle closure with pupil block

24. Narrow angle in POAG

26. TECHNIQUE OF IRIDOTOMY PUPIL IS MIOSED PRE-OP SITE:PERIPHERY OF IRIS,SUPERIOR IRIS 11-1 o clock position TO PREVENT THE IRRADIATION OF FOVEA. SUCCESSFUL IRIDOTOMY:GUSH OF PIGMENT DEBRIS

27. COMPLICATIONS: Bleeding Iritis Glare and diplopia Corneal burns

28. Surgery for congenital glaucoma Goniotomy Trabeculotomy trabeculectomy

29. goniotomy Done when cornea is clear or the angle can be visualised. Mech: Incision of obstructing trabecular meshwork Direct conduit between AC & schlemm canal Barkangoniotomy knife

31. Pre-op care: Acetazolamide:one week before to clear corneal opacity ARI & NLD obstruction – treated Complications: Post-op hyphema Injury to iris & lens DM detachment

32. TRABECULOTOMY Harm’s trabeculotome

33. Filtering proceduretrabeculectomy Patient selection:

35. Partial thickness scleral flap

36. A small hole in AC

37. Iridectomy at this point

38. Scleral flap closed with stitches

40. I.LIMBAL BASED CONJUNCTIVAL FLAP II.OUTLINE OF SUPERFICIAL SCLERAL FLAP

41. III.DISSECTION OF SUP.SCLERAL FLAP IV.INCISION FOR DEEP SCLERECTOMY

42. V.EXCISION OF DEEP SCLERAL BLOCK VI.PERIPHERAL IRIDECTOMY

46. VASCULARISED, NON-PENTRATING BLEB LEAKING BLEB

48. Over filtration

50. Blebitis

52. Dis adv:

53. Two types:

54. Deep sclerectomy

56. Sec. glaucoma-neo vascular glaucoma,aniridia

58. Complications: Excessive drainage Corneal decompensation Cataract Diplopia Late endophthalmitis Success rate:75%

59. Cyclo destructive procedures Surgical and laser procedures that ablate the ciliary body to lower the iop surgery:-cyclocryotherapy Laser-cyclophotocoagulation Feared complication:hypotony

60. Thank you!