Advanced glaucoma: challenge and achievement

Poster Details

First Author: S.Abdul-Kader LIBYAN ARAB JAMAHIRIYA

Co Author(s):    M. Krema              

Abstract Details

Purpose:

to evaluate the success rate of the chosen surgical procedure done

Setting:

retrospective comparative study

Methods:

retrospective study done on 41 eyes of 35 patients with advanced Gl selected randomly from Glaucoma clinic . All patients underwent assessmentIOPBCVACCTFundus photography , VF 24/2 or 10/2 , OCT -NFL analysis . Best procedure for every single patient has been chosen : Trab + mmc , Valve procedure or Diode Laser CPA , Improving Trab safety and Success by Slow lowering of IOP preoperative Mannitol , Paracentesis to Avoid Hypotony: ? Releasable or Adjustable Sutures was used to modify post op IOP , MMC was used in all patients underwent trabeculectomy . peribulbar or General Anesthesia with hypotensive tecnique were adopted .

Results:

Mean Pre-OP IOP = 37.4mmHg Mean Age = 49.2 years 46% female , 54% male . Etiological distribution : 23patients with POAG,4 PACG,12 Neovascular glaucoma,2aphakicGlaucoma . Surgical procedures : 27 patients (58.6%)underwent Trab with MMc , 10 patients (21.7%) underwent Ahmed valve insertion as primary procedure ,3(6.5%)patients underwent repeated procedures (Retrab +mmc in one patient ,2patients underwent Trab then Ahmed valve insertion latter ) releasable suture removed in 16 patients , and trab needling in 2 patients Successful outcome gained when Target IOP was achieved with or without medical therapy at the last 2 follow up visits successful results with achieved target IOP achieved in 100% of the cases : in 12patients on no topical treatment , in 25 patients on one drop , in 3 patients on 2 drops , and on 3 drops in one patient 6 patients(14%) underwent diode laser trans scleral cyclophotoablasion 3 patients (6.5%) underwent repeated procedures .

Conclusions:

Successful Results can be achieved Sometimes with difficulty and repeated procedures .Doctors have to overcome their phobia and encoraged to operate on Advanced glaucoma patient with more confidence . Webout did not happen in a single case .Swap positionsvision which is low in your judjement is the only vision he has . sometimes Independence is his or her only hope. So do your best to take proper decisionin the proper time doing and repeating proper procedures to preserve patient’s visual function reserve FINANCIAL DISCLOSURE?: No