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Glaucoma
Ashok Garg, Emanuel Rosen, Tanuj Dada, Ahmed K Khalil
SECTION 1: CLINICAL GLAUCOMA
1:
Early Onset Developmental Glaucoma (Primary Congenital Glaucoma)
INTRODUCTION
CLINICAL SIGNS AND SYMPTOMS
EXAMINATION
IOP
Cornea
The Optic Nerve Head
Gonioscopy
Axial Length Measurements
Differential Diagnosis
MANAGEMENT
Surgical Management
Deep Sclerectomy
Aqueous Shunt Implantation
MEDICAL TREATMENT
Prognosis
2:
Late (Adult) Onset Developmental Glaucoma
INTRODUCTION
CLINICAL SIGNS AND SYMPTOMS
DIFFERENTIAL DIAGNOSIS
TREATMENT
SURGICAL OPTIONS
PROGNOSIS
3:
Primary Infantile Glaucoma
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL FEATURES
SURGICAL TREATMENT
Introduction
Preoperative Management
Angle Surgery
Goniotomy
Trabeculotomy
Combined Trabeculotomy-Trabeculectomy
Trabeculectomy
Synthetic Drainage Implants
Cyclodestructive Procedures
Cyclocryotherapy
Transscleral Cyclophotocoagulation
Neodymium: YAG Lasers
Semiconductor Diode Lasers
LONG-TERM FOLLOW-UP
PROGNOSTIC FACTORS
4:
Open Angle Glaucoma
INTRODUCTION
Open Angle Glaucoma (OAG)—Definition
Open Angle Glaucoma Subtypes
PRIMARY OPEN ANGLE GLAUCOMA
Pathophysiology
Demographics
CLINICAL SIGNS AND SYMPTOMS
Functional Tests
Visual Field Testing
Optic Disc/Nerve Fiber Layer Imaging
Stereo Photography
Red Free Photography
Ocular Coherence Tomography—OCT and Heidelberg Retinal Tomography—HRT
GDx-Vcc
DIFFERENTIAL DIAGNOSIS
OAG SUBTYPES
Low Tension Glaucoma—Normal Tension Glaucoma
Pigment Dispersion Syndrome and Pigmentary Glaucoma
Pseudoexfoliation Syndrome and Pseudoexfoliative Glaucoma
Signs and Symptoms
Pathophysiology
Therapy
GLAUCOMA ASSOCIATED WITH OCULAR INFLAMMATION
Fuchs’ Heterochromic Cyclitis (FHC)
HERPETIC UVEITIS
Herpes Simplex
Varicella Zoster
GLAUCOMATOCYCLITIC CRISIS—POSNER AND SCHLOSSMAN
STEROID INDUCED GLAUCOMA
INTRAOCULAR BLEEDING AND HYPHEMA
Medical Therapy
Surgical Therapy
GHOST-CELL GLAUCOMA
PHACOLYTIC GLAUCOMA
TUMOR RELATED GLAUCOMA
STURGE-WEBER SYNDROME (SWS)
OAG TREATMENT
Medical Care
Laser Angle Surgery
Incisional Surgery
Drainage Implant (Seton/tube/shunt) Surgery
Ciliary Body Ablation
Prognosis
5:
Normal Tension Glaucoma
INTRODUCTION
GENETIC PREDISPOSITION AND EPIDEMIOLOGY
PATHOGENESIS
Intraocular Pressure
Vascular Factors
Other Factors
WORK-UP AND CLINICAL PRESENTATION
Neuroimaging
IOP
Other Glaucoma Parameters
Optic Disc Cupping
Visual Field
Retinal Nerve Fiber Layer (RNFL)
Disc Hemorrhages
Optic Disc Size
CCT
Systemic Associations
Differential Diagnosis with Masked HTG
MANAGEMENT
Medical Treatment
Beta-blockers
Surgical Treatment
6:
Pigment Dispersion Syndrome and Pigmentary Glaucoma
INTRODUCTION
CLINICAL SIGNS AND SYMPTOMS
Iris Changes
Corneal Changes
Anterior Chamber Changes
Lens Changes
Angle Changes
Pigment Deposition
Glaucoma
OCULAR EXAMINATION
PATHOGENESIS OF PIGMENT DISPERSION SYNDROME AND PIGMENTARY GLAUCOMA
Mechanism of Pigment Dispersion
Mechanisms of Intraocular Pressure Rise
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
TREATMENT
7:
Pseudoexfoliation Syndrome
INTRODUCTION
CAPSULAR DELAMINATION (TRUE EXFOLIATION)
EXFOLIATION SYNDROME
Clinical Signs and Symptoms
Lens Changes
Iris Changes
Angle Changes
Course of Glaucoma
Other Ocular Changes
PATHOGENESIS OF PSEUDOEXFOLIATION SYNDROME
EXFOLIATIVE MATERIAL
Nature
Source
Lens
Iris
Other Sources
MECHANISM OF PIGMENT DISPERSION
MECHANISM OF GLAUCOMA FORMATION
DIFFERENTIAL DIAGNOSIS OF PXS
Capsular Delamination (True Exfoliation)
Primary Familial Amyloidosis
Pigment Dispersion
INVESTIGATIONS
TREATMENT
PROGNOSIS
8:
Angle-closure Glaucoma
INTRODUCTION
Epidemiologic Aspects
Pathophysiology of Angle Closure
Predisposing Factors
CLINICAL SIGNS AND SYMPTOMS
Primary ACG
Secondary ACG
Investigations
Differential Diagnosis
Treatment
Prognosis
9:
Primary Angle-closure Glaucoma (PACG)
INTRODUCTION
CLASSIFICATION
CLINICAL CLASSIFICATION
Acute PACG
Intermittent PACG
Chronic PACG
Asymptomatic Narrow Angle (eye at risk of PACG)
Pathogenetic Classification
PACG due to Pupillary Block
PACG due to Direct Crowding of the Angle
PACG due to Mixed Mechanisms
Epidemiology
Angle-closure Mechanisms
Anatomical and Biometric Predisposition to PACG
Angle Closure due to Pupillary Block
Angle Closure due to Direct Crowding of the Angle
Angle Closure due to Mixed Mechanisms
Introduction to Therapy
Clinical Variants of PACG
Acute PACG
Essential Therapy for Acute Attack of PACG
Laser Iridotomy
Other measures
Corneal Indentation
Paracentesis of the Anterior Chamber
LASER PERIPHERAL IRIDOPLASTY
FILTERING SURGERY
Phacoemulsification of the Lens
Intermittent PACG
Therapy of intermittent PACG
Chronic PACG
Therapy of Chronic PACG
Chronicized PACG
Therapy of Chronicized PACG
Asymptomatic Narrow Angle (Eye at Risk of PACG)
Therapy of Asymptomatic Narrow Angle
PACG without Pupillary Block
10:
Malignant Glaucoma
INTRODUCTION
Synonyms
Definition
Clinical Importance
Onset
Other Clinical Forms
Pathophysiology
Shaffer's Hypothesis
Grant's Hypothesis
CLINICAL SIGNS AND SYMPTOMS
Predisposition
DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
MANAGEMENT
Medical Therapy
Surgical Therapy
Medical Therapy
Optimal Regimen of Medical Therapy
Argon Treatment of Ciliary Processes (Herscher)
Nd: Yag Laser Hyaloidotomy (Epstien)
Incisional Surgery
CHANDLER'S THREE-STEP SURGICAL CONFIRMATION PROCEDURE
Manual Technique
Automated Technique
PARS PLANA VITRECTOMY WITH AUTOMATED INFUSION SUCTION INSTRUMENTATION
FELLOW EYE
11:
Traumatic Glaucoma
INTRODUCTION
ETIOPATHOGENESIS
Mechanisms of Raised IOP in Penetrating Injuries
Mechanisms of Raised IOP in Contusion Injuries
Mechanism of Raised IOP Following Chemical Injuries
ELECTRIC SHOCK
RADIATION
THERMAL BURNS
CAUSES OF OPEN ANGLE GLAUCOMA FOLLOWING TRAUMA
Early Causes
Hyphema “Blood in AC”
PATHOPHYSIOLOGY OF BLUNT INJURY
PATHOPHYSIOLOGY IN PENETRATING INJURY
COURSE OF HYPHEMA
CLASSIFICATION OF TRAUMATIC HYPHEMA
Management
Medical Management
Surgical Management
Suggested Surgical Approaches
INFLAMMATION
LENS PARTICLE GLAUCOMA
Late Causes
Pathogenesis
CLASSIFICATION OF ANGLE RECESSION
Shallow
Moderate Tear
Deep Tear
CLINICAL FEATURES
TREATMENT
GHOST CELL GLAUCOMA
HISTORY AND TERMINOLOGY
PATHOGENESIS
CLINICAL FEATURES
DIFFERENTIAL DIAGNOSIS
Management
Prognosis
ANGLE CLOSURE GLAUCOMA FOLLOWING TRAUMA
Early Causes
Flat Anterior Chamber Leading to Formation of Peripheral Anterior Synechiae
Lens Subluxation
Lens Swelling
Uveal Effusion
Late Causes
Posterior Synechiae with Pupillary Block
Peripheral Anterior Synechiae
Epithelial Ingrowth following Penetrating Injury
Fibrovascular Downgrowth
Causes of Glaucoma
Neovascular Glaucoma
12:
Pediatric Glaucomas
INTRODUCTION
CLINICAL PRESENTATION
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
General
Surgical Intervention Options
Medical Treatment Options
Follow up
PROGNOSIS
13:
Glaucoma Implants in the Treatment of Pediatric Glaucoma
INTRODUCTION
CHOICE OF IMPLANT
OPERATION TECHNIQUE OF BAERVELDT IMPLANT
Complications
CONCLUSION
14:
Shunt Surgery for Refractory Glaucoma
REFRACTORY GLAUCOMA
History of Glaucoma Surgery
When to Consider a Glaucoma Shunt Device
Historical Aspects of the Shunt Procedure
Operating Technique
Complications
Hypertension Postoperatively
Corneal Decompensation
Exposure of the Tube and the Plate of the Glaucoma Shunt
Results from Literature
CONCLUSION
15:
Trabeculotome-guided Deep Sclerectomy
INTRODUCTION
SURGICAL TECHNIQUE
Schlemm's Canal Identification
Trabeculotome Placement
Schlemm's Canal Opening and Unroofing
Combined Phacoemulsification and Deep Sclerectomy
Advantages of the Technique
Disadvantages
CONCLUSIONS
16:
Glaucoma Drainage Implants
INTRODUCTION
HISTORICAL REVIEW
Principles for the Implantation of Glaucoma Drainage Device
Types of Glaucoma Tube Shunts
Non-restrictive Glaucoma Implants
The Molteno Implant. (lOP, Inc., Costa Mesa, Calif).
The Baerveldt Implant (Iovision, Irvine, Calif)
The White Pump Shunt (Tamcenan Corp, Sioux Falls, SO)
Schocket Band Implant
Ex-PRESS™ Miniature Glaucoma Implant (Boston Scientific, Inc, MA)
RESTRICTIVE GLAUCOMA IMPLANTS
The Joseph Valve
The Ahmed Valve (New World Medical, Inc, Rancho Cucamonga, Calif)
The Optimed Implant (OGPR;Optimed, Inc., Int., Santa Barbara, Calif)
Krupin Valve With Disk (Hood Laboratories, Pembroke, Mass)
Glaucoma Implants—Indication for Use
Technique
The One Stage Insertion
Two-Stage Insertion
Success
Use of Antifibrotics (Mitomicin-C and 5-FU)
Complications
Early Postoperative Complications
Late Postoperative Complications
Diplopia
Corneal Decompensation
SUMMARY
17:
Managing Aphakic Glaucoma in Children with AGV Valves
INTRODUCTION
SURGICAL PROCEDURE
The Surgical Technique Involved
Results
Bottom of Form
DISCUSSION
CONCLUSION
18A:
Absolute Glaucoma
INTRODUCTION
Clinical Features
Complications
Treatment
18B:
Primary Narrow Angle Glaucoma
INTRODUCTION
ETIOLOGY
Predisposing Factors
Anatomical
General
Precipitating Factors
Mechanism of rise of IOP
Clinical Features
Stages of Narrow Angle Glaucoma
Symptoms
Signs
Diagnosis
Differential Diagnosis
Treatment:
Surgical Management
Prophylactic Management (of the other asymptomatic eye)
Prognosis
18C:
Sturge-Weber Syndrome
INTRODUCTION
Clinical Features
Treatment
Prognosis
19:
New Investigations in Glaucoma
FREQUENCY DOUBLING PERIMETRY
Introduction
Principle
Method
Evaluating FDT Printouts
Testing Modes
Suprathreshold Strategy
Full Threshold Strategy
Custom 24-2 FDT Perimetry
Matrix FDT Perimetry
Screening Tests
Threshold Tests
Threshold Strategy Algorithm
Advantages of FDP
ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY
Introduction
Optical Principle
Uses
Advantages of ASOCT
Limitations of ASOCT
ULTRASOUND BIOMICROSCOPY
Introduction
Comparison of UBM versus ASOCT
Principle
Examination Technique
Contraindications
Uses
Limitations
RETINAL NERVE FIBER LAYER ANALYSIS USING SCANNING LASER POLARIMETRY
Introduction
Principle of Scanning Laser Polarimetry
Anterior Segment Birefringence and Variable Corneal Compensation (VCC)
RNFL Measurements
Measurement Technique
Clinical Interpretation of the GDx VCC Printout
The Thickness Map
The Deviation Map
The TSNIT Map
The Parameter
Abnormal Scan
Detecting Progression of RNFL loss: Serial Analysis
Guided Progression Analysis™ for GDx
Image Change
TSNIT Progression Graph
Parameter Progression Chart
Advantages of GDxVCC
Limitations
GDx-ECC: GDx—Enhanced Corneal Compensation
20:
Laser Procedures in Glaucoma
ARGON LASER TRABECULOPLASTY (ALT)
Introduction
Key Concepts
Mechanism of Action
Indication of ALT
Contraindications
Preoperative Work-up
Preoperative Preparation
Gonioprism
Laser Parameters
Placement of Burn
Ideal Reaction
Number of Burns
Postoperative Management
Complications of ALT
DIODE LASER CYCLOPHOTOCOAGULATION
Introduction
Key Facts
Indications for Cyclodestructive Procedures
Current Methods of Cycloablation
Mechanism of Action
Decreased Aqueous Production
Increased Aqueous Outflow
Technique
Settings
Probe Placement
Postoperative Regimen
Complications
Endocyclophotocoagulation
Postoperative Management
Complications
LASER PERIPHERAL IRIDOTOMY (LPI)
Introduction
Key Facts
Mechanism of Action
Indications
Contraindications
Preoperative Evaluation
Technique
Laser Settings
Site
End Point
Postoperative Management
Complications
21:
Laser Surgical Treatment of Glaucoma by Excimer Laser with 193 nm Wavelength
INTRODUCTION
PATIENTS AND METHODS
SURGICAL TECHNIQUE
RESULTS AND DISCUSSION
CONCLUSION
22:
Solid-state UV Laser for Minimally Invasive Glaucoma Surgery
INTRODUCTION
NPDS: AN EVOLUTIONARY TECHNIQUE
UV-270
Customized Laser Assisted Non-penetrating Deep Sclerostomy
23:
Trabecular Meshwork Ablation as an Alternative to Invasive Glaucoma Surgery
INTRODUCTION
ERBIUM-YAG GONIOTOMY
EXCIMER LASER TRABECULOTOMY (ELT)
Background
Surgical Procedure
STUDY RESULTS
CONCLUSION
24:
Non-penetrating Filtration Surgery with the CO2 Laser
INTRODUCTION
PRECLINICAL STUDIES
CLINICAL STUDIES
SUMMARY
VIDEO
25:
Selective Laser Trabeculoplasty
INTRODUCTION
MECHANISM OF ACTION
LASER AND DELIVERY SYSTEM
TANGO LASER FROM LASERX
OPERATIVE TECHNIQUE
INDICATIONS AND CONTRAINDICATIONS
ADVERSE EFFECTS
BENEFITS OF SLT
CLINICAL TRIALS
SUMMARY
SECTION 2: SPECIAL GLAUCOMA SURGICAL TECHNIQUES
26:
Drainage Implant Surgery
INTRODUCTION
Valveless Shunts
Valved Implants
Indications
The Baerveldt Implant
The Ahmed Valve
Potential Shunt Risks
Aqueous Shunts in Pediatric Group
Surgical Technique
Basic Principles
Postoperative Care
Complications
Hypotony
Elevated Intraocular Pressure
Ocular Motility Disturbance
Tube or Plate Extrusion
Problems of Tube Migration
Results of Implants
SUMMARY
27:
Pneumatic Trabeculoplasty: A Noninvasive Glaucoma Treatment
CONCLUSION
28:
Combined Phacoemulsification and Deep Sclerectomy with T-Flux ®
INTRODUCTION
SURGICAL TECHNIQUE
Personal Study
CONCLUSION
29:
Sclerothalamotomy Ab Interno: A Minimally Invasive Surgical Option for Glaucoma
INTRODUCTION
PATIENTS AND METHODS
High-frequency Diathermic Probe
Surgical Procedure
Evaluation of the Results
RESULTS
DISCUSSION
30:
Sutureless Filtration Surgery in Glaucoma
INTRODUCTION
Subjects Suitable for Sutureless Filtration Surgery
Preoperative Documentation
SURGICAL PROCEDURE
Photographic Illustrations of Surgical Steps Postoperative Documentation
Author's Personal Observations
31:
Viscocanalostomy
INTRODUCTION
MECHANISM OF ACTION
SURGICAL TECHNIQUE
INDICATIONS
RESULTS
Retrospective Studies
Prospective Studies
Randomized Controlled Studies
CONCLUSIONS
32:
Open Angle Filter Surgery for Glaucoma Deep Sclerocanalostomy (DSC): New Technique
HISTORY
ANATOMO-PHYSIOLOGY
New Techniques
Choices for Dissection
Conjunctival shutter with limb
Stages are as follows
1st Scleral Flap
2nd Scleral flap
Schlemm Canal Dissection
Canalostomy
Implant/Mitomycin C
Postoperative treatment
Postoperative checkups
Preoperative Complications
Postoperative Complications
33:
Milling Trabeculoplasty: A New Technique for Non-penetrating Glaucoma Surgery
INTRODUCTION
INDICATIONS
PATIENT PREPARATION
Milling surgical procedure
Surgical Steps
Postoperative Follow Up
RESULTS
Group I (Milling procedure)
Group II (Milling procedure combined with phaco)
DISCUSSION
CONCLUSION
34:
G-probe as Primary Glaucoma Procedure in Cases of Coexisting POAG and Cataract
INTRODUCTION
Materials and Methods
Results
Conclusion
Different Protocols and Treatment Strategies are Found in the Literature
35:
Very Deep Sclerectomy or How to Increase Uveoscleral Outflow
INTRODUCTION
GENERALITIES
SURGICAL TECHNIQUE
PRELIMINARY RESULTS
POSTOPERATIVE MANAGEMENT
CONCLUSION
36:
Glaucoma Surgery with Fugo Plasma Blade
TRANS-CILIARY FILTRATION (SINGH FILTRATION)
Trans-conjunctival Trans-ciliary Filtration (TC-TCF)
Singh Microtrack Filtration
Ab-interno Filtration with Fugo Blade
To sum up
37:
Bimanual MicroPhaco and Deep Sclerocanalostomy (BMP and DSC): New Technique
INTRODUCTION/INDICATIONS
Surgical technique
1st Scleral Flap
Choices for dissection
Conjunctival shutter with limb
1st Scleral flap:
2nd Stage Cataract
Lens implantation
3rd Glaucoma
2nd Scleral flap
Schlemm Canal Dissection
Canalostomy
Implant/Mitomycin C
Postoperative treatment
Complications during the Operation
Postoperative Complications
38:
Modern Glaucoma Surgery
METHODS
RESULTS
Complications
Results with the PDS suture
Discussion
CONCLUSION
39:
Deep Sclerectomy with T-Flux Implant with “Outside In” Drainage
INTRODUCTION
NATURE'S DRAINAGE CHANNELS
ENSURE SURGICAL SUCCESS
HISTORY OF THE PROCEDURE
DEEP SCLERECTOMY WITH T-FLUX IMPLANT
THE FLIP SIDE
DEEP SCLERECTOMY WITH T-FLUX IMPLANT WITH SUPRACHOROIDAL DRAINAGE
THE SURGICAL PROCEDURE
Follow-up visit protocol is as under:
CONCLUSION
INDEX
TOC
Index
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