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Chapter-31 Trabecular Meshwork Ablation as an Alternative to Invasive Glaucoma Surgery

BOOK TITLE: Surgical Techniques in Ophthalmology: Glaucoma Surgery

Author
1. Pache Mona
2. Funk Jens
ISBN
9788184489583
DOI
10.5005/jp/books/11383_31
Edition
1/e
Publishing Year
2010
Pages
5
Author Affiliations
1. Augenklinik-Universitatsklinikum, Killianstr. 5, 79106 Freiburg, Germany, Augenklinik-Universitats Klinikum, Killian Str 5, 79106 Freiburg, Germany, Augenklinik-Universitatsklinikum, Killianstr 5, 79106 Freiburg, Germany
2. Augenklinik-Universitatsklinikum, Killianstr. 5, 79106 Freiburg, Germany, Augenklinik-Universitats Klinikum, Killian Str 5, 79106 Freiburg, Germany, Augenklinik-Universitatsklinikum, Killianstr 5, 79106 Freiburg, Germany
Chapter keywords
open angle glaucoma, glaucomatous optic neuropathy (GON), retinal ganglion cells, optic nerve head (ONH), intraocular pressure (IOP), aqueous humor, trabecular meshwork, argon laser trabeculoplasty (ALT), excimer-laser-trabeculotomy

Abstract

Open angle glaucoma is the second leading cause of blindness in the world. Glaucomatous optic neuropathy (GON) is characterized by a loss of retinal ganglion cells and their axons, associated by a tissue remodeling both of the optic nerve head (ONH) and the retina leading to the characteristic ONH cupping. Many glaucoma patients present with elevated intraocular pressure (IOP), most often caused by reduced outflow capacity of aqueous humor. The outflow resistance is localized at the level of the trabecular meshwork, or more precisely, at the juxtacanalicular meshwork and the inner wall of Schlemm’s canal. Glaucoma surgery includes, nowadays, a number of potential therapies all aiming either to increase the outflow of aqueous humor or to decrease its production. Argon laser trabeculoplasty (ALT), for example, increases the conventional outflow through the trabecular meshwork and is easy to perform. Erbium-YAG goniotomy and excimer-laser-trabeculotomy are explained. Excimer-laser-trabeculotomy is a promising IOP-lowering technique both as a stand-alone procedure and in combination with cataract surgery. It is especially suitable for patients with high preoperative IOP levels and can easily be combined with cataract surgery.

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