Are newer surgical interventions for glaucoma making a difference?

Au, Leon

doi:10.1136/bjophthalmol-2013-303681

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…The resulting RGC and RNFL thickness maps should be turned into probability/deviation maps to facilitate comparison with VFs. 1 , 2 , 25 Second, VFs should be obtained with a pattern that includes a finer test grid in the macular area or 24-2 and 10-2 tests should be performed within the first two visits. Finally, instead of conventional metrics, VF and OCT results should be compared topographically.…”

Section: Implications For the Ccpmentioning

confidence: 99%

“…That is, abnormal points seen on VFs should agree topographically with the local abnormal regions on RGC and RNFL probability maps, and this region of agreement should resemble known patterns of glaucomatous damage. 2 , 25 …”

Section: Implications For the Ccpmentioning

confidence: 99%

“…We have designed a one-page report that incorporates these suggestions. 2 , 25 , 26 Two OCT manufacturers are incorporating the basic elements of these suggestions in a new report, and a third has a report that has some of these elements.…”

Section: Implications For the Ccpmentioning

confidence: 99%

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Challenges to the Common Clinical Paradigm for Diagnosis of Glaucomatous Damage With OCT and Visual Fields

Hood

Moraes

2018

Invest. Ophthalmol. Vis. Sci.

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The most common clinical paradigm (CCP) for diagnosing glaucoma includes a visual field (VF) with a 6° test grid (e.g., the 24-2 or 30-2 test pattern) and an optical coherence tomography (OCT) scan of the optic disc. Furthermore, these tests are assessed based upon quantitative metrics (e.g., the pattern standard deviation [PSD] of the VF and the global retinal nerve fiber thickness of the OCT disc scan). This CCP is facing three challenges. First, the macular region (i.e., ±8° from fixation) is affected early in the glaucomatous process, and the CCP can miss and/or underestimate the damage. Second, use of the typical VF and OCT metrics underestimates the degree of agreement between structural (OCT) and functional (VF) damage. Third, resolution of the OCT scan has improved, and local glaucomatous damage can be visualized like never before. However, the clinician often does not look at the OCT scan image. Together these challenges argue for a modification of the VF test pattern and OCT protocol, replacement of metrics with a comparison of abnormal regions on VF and OCT, and careful inspection of actual OCT scan images. In principle, the CCP could be modified easily. In practice, change is facing a number of impediments.

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Section: Implications For the Ccpmentioning

confidence: 99%

Section: Implications For the Ccpmentioning

confidence: 99%

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Challenges to the Common Clinical Paradigm for Diagnosis of Glaucomatous Damage With OCT and Visual Fields

Hood

Moraes

2018

Invest. Ophthalmol. Vis. Sci.

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“…They are indicated for mild to moderate glaucoma, whereas IOP is reduced to mid-to-high teens, preferably combined with cataract extraction. Furthermore, most MIGS are fast to perform, have a more rapid visual recovery, and have a lower complication rate than filtration surgery (11,12) . Nonetheless, there is limited data on costs, as well as on how they could negatively affect a future trabeculectomy.…”

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confidence: 99%

Open-angle glaucoma surgery: the current standing

Tavares¹

2014

Arquivos Brasileiros De Oftalmologia

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Glaucoma is an optic neuropathy characterized by progressive degeneration of retinal ganglion cells (1) . It is the main cause of irreversible blindness in the world, and affects more than 70 million people worldwide, being 10% bilaterally blind (2) . Glaucoma can remain asymptomatic until it is severe, leading glaucoma filtration surgery to be performed in advanced cases, often by general ophthalmologists, which may be, in part, responsible for the wrong impression of its low success-rates and high incidence of complications. Therefore, glaucoma surgery is feared by patients and even by some ophthalmologists. Nevertheless, recently published studies on glaucoma surgery safety and efficacy have reported a different reality.First, due to recent diagnostic and therapeutic advancements, including improvements in surgery techniques, the 20-year probability of glaucoma-related blindness in at least one eye was reduced to half during the period from 1965 to 2009 (3) . One of these enhancements was the advent of the safe trabeculectomy technique, proposed by Peng Khaw from the Moorfields Eye Hospital (4) . Moreover, a multicenter analysis showed that good trabeculectomy outcomes with low rates of surgical complications can be achieved, but intensive proactive postoperative care is required. These authors showed an intraocular pressure (IOP) equal or less than 18 mmHg in 86% of the patients after a two-year follow-up period, when included hypotensive medication use (5) . They also reported antifibrotics use in 93% of the cases, what corroborated the current practice pattern among glaucoma specialists. The use of mitomycin-C (MMC) during trabeculectomy has not only enhanced its IOP-lowering effect, but also made the postoperative period more challenging. Suture manipulation (including massage, laser suture lysis, etc.), bleb needling and subconjunctival 5-fluorouracil injections are directly related to success, and demand both time and expertise. In the same report, 31 patients (7%) had late-onset hypotony (three of them with visual acuity decreased by >2 Snellen lines), and two patients developed bleb-related endophthalmitis (5) . Incidentally, another recent paper reported that visual loss after surgery, the "wipe-out" phenomenon, is rare, even in patients with advanced glaucomatous visual field loss and split fixation (6) . The Ex-Press ® implantation during glaucoma filtration surgery should be considered as a modification in trabeculectomy, and not as an entirely new procedure. A recent meta-analysis of randomized clinical trials comparing both procedures reported similar efficacy in IOP-lowering, medication reduction, vision recovery, qualified operative success-rates, and a greater incidence of most complications, with the exception of hyphema (7) . Controversy over its application in daily practice exists, as its efficacy and safety are similar to trabeculectomy, however it makes the procedure more costly.Non-penetrating surgical procedures, including deep sclerectomy (DS), are more difficult to perform and requi...

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