Surgical management of glaucoma: a review

Abstract

This review will briefly describe the history of surgical glaucoma treatment and concentrate on the current surgical strategies for managing glaucoma. A discussion of treatments for angle closure, open-angle glaucoma and paediatric glaucoma with an emphasis on drainage surgery are included. The role of cataract surgery is also briefly described. Drainage surgery evolved from peripheral iridectomy and sclerotomy with an increasing understanding of aqueous flow within the eye and the production of a functioning bleb. The current mainstays include trabeculectomy, glaucoma drainage devices as well as goniotomy and trabeculotomy, which have all been in existence for more than 40 years. Their various advantages as well as methods used to minimize their disadvantages, including the antimitotics and case selection are discussed. We finish by discussing the preliminary results of some newer forms of drainage surgery illustrating the energetic search for methods to minimize the problems of hypotony and bleb failure.

Recent trends in glaucoma surgery in Scotland, England and Wales

“…This reflects the rarer indications for aqueous shunts: refractory glaucoma, previous failed filtration surgery, rubeotic glaucoma, traumatic glaucoma, inflammatory glaucoma and congenital glaucoma 6. Rates of aqueous shunts have increased from 2003 to 2012 in all groups with the largest increase in those over 60 years (figure 1 and table 2).…”

“…Following the introduction and widespread use of prostaglandin analogues and carbonic anhydrase inhibitors there was a rapid fall in trabeculectomy rates in the late 1990s throughout the UK 2–5. Glaucoma drainage devices or aqueous shunts, the preferred term used by the American National Standards Institute, were traditionally reserved for cases of refractory glaucoma where trabeculectomy had failed or was likely to fail 6. A growing experience of these devices has led to wider clinical indications, however, there is no current data on trends in their usage 6 7…”

Tetramethylpyrazine Attenuates Transdifferentiation of TGF-β2–Treated Human Tenon's Fibroblasts

“…Samples were immediately transferred into saline solution and sent for lab analysis. Fresh tissue was minced, seeded onto 60-mm culture dishes, and maintained in Dulbecco's modified Eagle's medium (DMEM)/F12 (Gibco, Carlsbad, CA, USA) containing 10% fetal bovine serum (FBS, Gibco) and 1% penicillin/streptomycin (Gibco) at 378C in 5% CO 2 .…”

“…2,3 Currently, the most effective treatment for bleb scarring is an antimetabolite, such as mitomycin-C or 5-fluorouracil. This is a drastic and suboptimal approach, associated with severe and potentially blinding complications.…”

Managing antiplatelet and anticoagulant drugs in patients undergoing elective ophthalmic surgery

“…Of the wide range of glaucoma surgical procedures, trabeculectomy is the most common 25. Intraoperative or postoperative bleeding complications, including hyphaema, intrableb bleeding and suprachoroidal haemorrhage have been reported which can result in failure of the filtration procedure or loss of sight.…”