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Adult Glaucoma Surgery
Maria da Luz Freitas, João Eurico Lisboa, Queiroz Marinho
1:
Trabeculectomy
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
PREOPERATIVE ASSESSMENT
Surgical Technique
Anesthesia
Opening of the Conjunctiva
Scleral Flap
Paracentesis
Sclerectomy
Iridectomy
Conjunctival Closure
METHODS TO PREVENT SCARRING OF THE FILTRATION BLEB
Antimetabolites
Bleb-Forming Implants
Anti-VEGFs
INTRAOPERATIVE COMPLICATIONS
Hyphema
Athalamia
Vitreous Loss
Expulsive Hemorrhage
IMMEDIATE POSTOPERATIVE COMPLICATIONS
Hypothalamia with Ocular Hypotony
Hyphema
Choroidal Detachment
Hypotonic Maculopathy
Hypothalamia with Ocular Hypertony
Suprachoroidal Hemorrhage
Intraocular Infection
Ocular Hypertension
Encapsulated Bleb
Needling Technique
LATE POSTOPERATIVE COMPLICATIONS
Late Hypotony
Cataracts
FINAL REMARKS
2:
ExPressTM— Mini Glaucoma Shunt
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
SURGERY
Anesthesia
Surgical Technique
POSTOPERATIVE THERAPY
COMPLICATIONS
Intraoperative
Postoperative
CONCLUSION
3:
Posterior Drainage Devices
INTRODUCTION
DEVICE CHARACTERISTICS
Presence or Absence of a Flow Restriction Mechanism (Restrictive Versus Nonrestrictive)
Plate Surface Area
Composition
CLASSIC INDICATIONS
Eyes in Which Trabeculectomy With Mitomycin C (MMC), even With Adjunctive Antimetabolite Use, Have a High-Risk of Failure
Eyes in Which Trabeculectomy is Technically Not Possible or Has a High-Risk of Intraoperative Complications
Patients in Whom Trabeculectomy With MMC Has a Very High-Risk of Postoperative Complications
RECENT INDICATIONS
Relative Contraindications14
PREOPERATIVE ASSESSMENT
GENERAL ASSESSMENT
TYPES OF ANESTHESIA
SURGICAL TECHNIQUE
Globe Fixation
Conjunctival Flap
Plate Insertion and Fixation
Paracentesis
Tube Insertion
Tube Covering
Heterologous Sclera
Dura Mater, Pericardium, Fascia Lata
Conjunctival Suture
TECHNIQUE VARIANTS1, 15
Tube Insertion in the Posterior Chamber
Tube Insertion in the Pars Plana
Technique Variations to Avoid Early Postoperative Hypotony (Nonvalved Implants)
Two-Stage Surgery
Intraluminal Stent
Occlusive Sutures
Combination of Occlusive Sutures and Intraluminal Stent
Use of Antiscarring Agents
Postoperative Complications
Early Hypotony
Transient Hypertensive Phase
Tube- or Plate-Related Complications
Tube Retraction
Anterior Migration
Proximal Obstruction
Late Tube Erosion
Endophthalmitis
Implant Expulsion
Corneal Complications
Changes in Extrinsic Ocular Mobility
Other Complications of Glaucoma Surgery
REMARKS
4:
Deep Sclerectomy
INTRODUCTION
INDICATIONS
Strictu Sensu
Relative Contraindications
Absolute Contraindications
PATIENT'S ASSESSMENT
SURGICAL TECHNIQUE
DIFFICULTIES/COMPLICATIONS AND THEIR INTRAOPERATIVE RESOLUTION
Depth of Deep Scleral Flap
Perforation of Trabeculodescemetic Window
IMMEDIATE POSTOPERATIVE COMPLICATIONS AND RESOLUTION OF COMPLICATIONS (1–10 DAYS)10
Seidel
Inflammation
Hypotony
High Intraocular Pressure
Choroidal Detachment
Low Anterior Chamber
Hematic Tyndall/Hyphema
Descemet's Membrane Detachment
Reduced Visual Acuity
LATE POSTOPERATIVE COMPLICATIONS AND RESOLUTION OF COMPLICATIONS (2–5 WEEKS)
Increased Intraocular Pressure
Blebitis
REMARKS
5:
Gonioscopic Surgery: Trabecular Micro-Bypass Stent Implantation
INTRODUCTION
6:
Canaloplasty
INTRODUCTION
INDICATIONS
RELATIVE CONTRAINDICATIONS
ABSOLUTE CONTRAINDICATIONS
PATIENT'S ASSESSMENT
SURGICAL TECHNIQUE
Preoperative Preparation
Surgery Location
Scleral Flaps, Opening of Schlemm's Canal Opening and Creation of a Trabeculodescemetic Window
Catheterization, Dilation and Distention of Schlemm's Canal
Closure of Scleral Flap and Conjunctiva
Difficulties/Complications and their Intraoperative Resolution
Depth of Deep Scleral Flap
Perforation of Trabeculodescemetic Window
Canal Catheterization
Hyphema
Immediate Postoperative Complications and Resolution of Complications (1–10 Days)
Hematic Tyndall/Hyphema
Ocular Hypertension
Hypotony
Descemet's Membrane Detachment
Low Anterior Chamber
Choroidal Detachment
Reduced Visual Acuity
Late Postoperative Complications and Resolution of Complications (2–5 Weeks)
Increased Intraocular Pressure
Suture Exposure in the Anterior Chamber
REMARKS
7:
Combined Surgery
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
PATIENT'S CLINICAL EVALUATION
SURGICAL TECHNIQUE AND COMPLICATIONS
FINAL REMARKS
8:
Lens Surgery in Glaucoma
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
CLINICAL EVALUATION OR PATIENT EVALUATION
DESCRIPTION OF SURGICAL TECHNIQUE, DIFFICULTIES AND THEIR RESOLUTION
Immediate Postoperative Complications and Resolution of Complications
REMARKS
INDEX
TOC
Index
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