Trabeculectomy – Prevention and Management of Complications

Sousa, David Cordeiro; Pinto, Luís Abegão

doi:10.17925/eor.2018.12.2.98

Cited by 3 publications

(2 citation statements)

References 34 publications

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“…Although it has the potential for success, trabeculectomy may be more challenging in certain cases because to aqueous misdirection (Sousa & Pinto, 2018). A significant inflammatory response followed by bleb failure (7).…”

Section: Resultsmentioning

confidence: 99%

Eye Emergency: A Case Report On Acute Primary Angle Closure

Rasyda,

Nurwasis,

Rosarina

2024

ijsh

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Acute Primary Angle Closure (APAC) or Acute Glaucoma is a condition where intraocular pressure rapidly increases due to the occlusion of the trabecular meshwork by the iris. This case report aims to present the clinical manifestations of APAC and evaluate the initial treatment strategies to immediately reduce intraocular pressure (IOP) and prevent visual loss. A 63-year-old woman presented with a sudden onset of pain in her left eye, accompanied by redness, headache, blurred vision, and nausea. Her visual acuity in the left eye was 1/300, with an IOP of 69.3 mmHg. Slit-lamp examination revealed hyperemic conjunctiva, mixed conjunctival and pericorneal injection, corneal edema, a shallow anterior chamber with Van Herrick grade I, radially dilated iris, a mid-dilated pupil (4 mm in diameter), and a cloudy lens. Gonioscopy confirmed a closed angle and peripheral anterior synechiae (PAS). The right eye had a shallow anterior chamber with normal IOP. Initial treatment included oral glycerin, intravenous analgesic, oral acetazolamide 250 mg, potassium chloride 600 mg, and topical beta-blocker 0.5%, but showed no improvement. Subsequently, a trabeculectomy was performed. The patient also underwent Laser Peripheral Iridotomy (LPI) on the right eye. This case underscores that acute primary angle closure is an ophthalmic emergency, and timely management is crucial to prevent further complications and visual loss. Postoperative follow-up indicated a significant reduction in IOP and stabilization of visual acuity, highlighting the importance of rapid intervention in APAC cases.

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Section: Resultsmentioning

confidence: 99%

Eye Emergency: A Case Report On Acute Primary Angle Closure

Rasyda,

Nurwasis,

Rosarina

2024

ijsh

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“…Besides subconjunctival scarring that leads to increased IOP, hypotony is one of the most common complications following glaucoma surgery. It is defined as very low IOP of 5 mmHg or less, and it may lead to vision loss in up to 20% of the patients who experience hypotony [14]. The acute inflammatory response that naturally follows incisional surgery may also contribute to hypotony-more permeable/leaky subconjunctival capillaries may absorb the aqueous humor at a faster rate than it is produced, thus leading to over-filtration [15].…”

Section: Plos Onementioning

confidence: 99%

A model for designing intraocular pressure-regulating glaucoma implants

et al. 2022

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Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for vision. The key risk factor for the development and progression of this disease is increased intraocular pressure (IOP). Implantable glaucoma drainage devices have been developed to divert aqueous humor from the glaucomatous eye as a means of reducing IOP. The artificial drainage pathway created by these devices drives the fluid into a filtering bleb. The long-term success of filtration surgery is dictated by the proper functioning of the bleb and overlying Tenon’s and conjunctival tissue. To better understand the influence of the health condition of these tissues on IOP, we have developed a mathematical model of fluid production in the eye, its removal from the anterior chamber by a particular glaucoma implant–the PRESERFLO® MicroShunt–, drainage into the bleb and absorption by the subconjunctival vasculature. The mathematical model was numerically solved by commercial FEM package COMSOL. Our numerical results of IOP for different postoperative conditions are consistent with the available evidence on IOP outcomes after the implantation of this device. To obtain insight into the adjustments in the implant’s hydrodynamic resistance that are required for IOP control when hypotony or bleb scarring due to tissue fibrosis take place, we have simulated the flow through a microshunt with an adjustable lumen diameter. Our findings show that increasing the hydrodynamic resistance of the microshunt by reducing the lumen diameter, can effectively help to prevent hypotony. However, decreasing the hydrodynamic resistance of the implant will not sufficiently decrease the IOP to acceptable levels when the bleb is encapsulated due to tissue fibrosis. Therefore, to effectively reduce IOP, the adjustable glaucoma implant should be combined with a means of reducing fibrosis. The results reported herein may provide guidelines to support the design of future glaucoma implants with adjustable hydrodynamic resistances.

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Conventional glaucoma implants and the new MIGS devices: a comprehensive review of current options and future directions

Pereira

Wijdeven

Wyss

et al. 2021

Eye

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Glaucoma is a progressive optic neuropathy that is the second leading cause of preventable blindness worldwide, after cataract formation. A rise in the intraocular pressure (IOP) is considered to be a major risk factor for glaucoma and is associated with an abnormal increase of resistance to aqueous humour outflow from the anterior chamber. Glaucoma drainage devices have been developed to provide an alternative pathway through which aqueous humour can effectively exit the anterior chamber, thereby reducing IOP. These devices include the traditional aqueous shunts with tube-plate design, as well as more recent implants, such as the trabeculectomy-modifying EX-PRESS® implant and the new minimally invasive glaucoma surgery (MIGS) devices. In this review, we will describe each implant in detail, focusing on their efficacy in reducing IOP and safety profile. Additionally, a critical and evidence-based comparison between these implants will be provided. Finally, we will propose potential developments that may help to improve the performance of current devices.

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Trabeculectomy – Prevention and Management of Complications

Cited by 3 publications

References 34 publications

Eye Emergency: A Case Report On Acute Primary Angle Closure

Eye Emergency: A Case Report On Acute Primary Angle Closure

A model for designing intraocular pressure-regulating glaucoma implants

Conventional glaucoma implants and the new MIGS devices: a comprehensive review of current options and future directions

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