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III. Glaucoma Management > Surgical Management of Glaucoma (F) > Flashcards

Surgical Management of Glaucoma (F) Flashcards

1
Q

What are the trabeculectomy post-op meds (dosage)?

A
  1. cycloplegic (1-2 weeks post-op)
  2. corticosteroids (Pred Forte) (tapered over 2 months)
  3. antibiotic (QID 1-4wks)
  4. digital ocular compression
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2
Q

What is the MIGS procedure where they do a viscocanalostomy and then have suture all the say around Schlemm’s canal and tighten to increase tension and patency of canal?

A

Canaloplasty

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3
Q

What is the treatment for bleb associated endophthalmitis?

A
  1. Consultation with vitreo-retinal specialist
  2. Pars Plana Vitrectomy (PPV)
  3. Vitreous tap
  4. Vitreal antibiotic injection
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4
Q

What does the corticosteroid provide as a trabeculectomy post-op med?

A
  1. Decreases fibroblast proliferation
  2. Increases aqueous outflow
  3. Promotes bleb formation
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5
Q

What is the MIGS procedure where they enter into Schlemm’s canal, open it up and force through viscoelastic to flush out debris and clean it out?

A

viscocanalostomy

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6
Q

When is Mitomycin C applied during a trabeculectomy? 1. What are the adverse effects? 2

A
  1. intraoperatively

2. Toxic to corneal endothelial cells, Bleb encapsulation, Hypotony, Maculopathy

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7
Q

What does the antibiotic provide as a trabeculectomy post-op med?

A

Prevents infection/endophthalmitis

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8
Q

What are the risk factors for blebitis and bleb associated endophthalmitis?

A
  1. Late onset bleb leak
  2. Blepharitis
  3. h/o recurrent bacterial conjunctivitis
  4. Use of anti-metabolites
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9
Q

How many meds does a canaloplasty patient end up having following the procedure?

A

0.1

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10
Q

What is a domelike, thick-walled, opalescent bleb that clogs filter and increases IOP? 1. When does it typically occur? 2. What is it due to? 3. What is the treatment? 4

A
  1. encapsulated bleb (“cyst”)
  2. 2-12 weeks
  3. proliferation of fibroblasts
  4. topical corticosteroid and digital massage
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11
Q

What were the findings of the Collaborative Initial Glaucoma Treatment Study (CIGTS)?

A
  1. trabeculectomy lessens IOP by about 3mmHg with no significant difference of quality of life compared to medications
  2. trab best for advanced initial VF loss
  3. not recommended for diabetics and african americans
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12
Q

What did the AGIS study show?

A

When managing advanced glaucoma patients, it may be more beneficial for African American patient to have ALT before Trabeculectomy and Caucasians to have Trabeculectomy before ALT

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13
Q

What is an infection of a trab bleb without intraocular involvement and with mucopurulent infiltrate?

A

blebitis

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14
Q

What did the Glaucoma Laser Trial show?

A
  1. Eyes with ALT had 1.2mmHg greater IOP reduction than timolol
  2. Eyes with ALT had 0.6dB less VF progression than timolol`
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15
Q

What is the treatment co-management procedure for ALT?

A
  1. Topical anesthesia

2. Goldmann 3-mirror goniolens; typically laser 180° per session (about 50 laser shots, 3-4º apart)

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16
Q

What is the posttreatment co-management procedure for ALT?

A
  1. 1 drop AlphaganP or Apraclonidine immediately following laser
  2. Prednisolone acetate 1% QID x 5-7 days
  3. IOP checks at: 1-2 hours post-op; 1-2 days if high post-op IOP AND 7-10 days; 6-7 weeks
17
Q

What is fibrovascular proliferation of the angle called?

A

neovascularization of the angle (NVA)

18
Q

What is the pretreatment co-management procedure for ALT?

A
  1. Informed consent prior to surgery
  2. 1 drop AlphaganP or Apraclonidine 30-60 minutes prior to laser
  3. Optional*:1 drop of Pilocarpine to enhance view of angle structures
19
Q

What is the treatment for neovascularization of the angle (NVA)?

A
  1. PRP (Eliminates the stimulus for NV and Treat before PAS formation)
  2. Anti-angiogenic agents (i.e. Lucentis)
  3. Filter surgery/tube shunt
  4. Cyclophotocoagulation
20
Q

What is the pretreatment co-management procedure for SLT?

A
  1. Informed consent prior to surgery
  2. 1 drop AlphaganP or Apraclonidine 30-60 minutes prior to laser
  3. Optional, but common: 1 drop of Pilocarpine to enhance view of angle structures
21
Q

What is the treatment co-management procedure for SLT?

A
  1. Topical anesthesia

2. Goldmann 3-mirror goniolens or Latina SLT lens, either full 360º or 180º application done per eye

22
Q

What are the surgical options for a patient with an open angle?

A
  1. laser outflow procedures
  2. penetrating filter procedures
  3. microinvasive glaucoma surgery (MIGS)
  4. cyclophotocoagulation
23
Q

What are the surgical options for phacomorphic glaucoma?

A

cataract extraction

24
Q

What are the indications for a surgical referral with glaucoma?

A
  1. Maximum tolerated medical therapy (MMT) with progression or not target IOP
  2. medication failure
  3. unable to instill eye drops
  4. poor compliance
  5. patient preference
  6. phacomorphic glaucoma
  7. neovascular glaucoma
  8. developmental glaucoma
25
Q

What does the cycloplegic provide as a trabeculectomy post-op med?

A
  1. Deepens anterior chamber
  2. Prevents posterior synechiae
  3. Maintains blood-aqueous barrier
  4. Decreases ciliary spasm
26
Q

What are the signs of wound leak following a trab?

A
    • Seidel sign
  2. flat bleb
  3. low IOP
  4. shallow anterior chamber if develop hypotony
27
Q

What did the SLT/MED study show?

A
  1. Both PG’s and SLT have average ↓IOP of 27% at 1 year

2. SLT is good at reducing diurnal IOP curve

28
Q

When is 5-Fluorouracil applied during a trabeculectomy? 1. What are the adverse effects? 2

A
  1. post-op subconjunctival injections
  2. Corneal SPK, Infection, Subconjunctival hemorrhage from repeat
    injections, May lead to scarring
29
Q

What are the surgical options for neovascular glaucoma?

A

pan retinal photocoagulation (PRP)

30
Q

What is the full thickness glaucoma filtration surgery that drains aqueous directly into sub conjunctival space? 1. What is the issue with this surgery? 2

A
  1. “open” sclerostomy

2. high risk of complications (infection, hypotony)

31
Q

What is the treatment for blebitis?

A
  1. Topical FQ antibiotic (Besivance) q1h
  2. Oral Ciprofloxacin 500mg BID
  3. Daily follow up to ensure doesn’t progress to endophthalmitis
32
Q

What is management of wound leak following a trab?

A
  1. Corticosteroid reduction
  2. Large Diameter Bandage Soft Contact lens
  3. Antibiotics (Aminoglycosides)
    If hypotony is not present: use aqueous suppressants to reduce pressure and prevent outflow thru leak: B-blocker, Alpha
    agonist
33
Q

What are the surgical options for a patient with an narrow angle/angle closure?

A
  1. peripheral iridotomy
  2. peripheral iridectomy
  3. peripheral iridoplasty/gonioplasty
  4. goniosynechialysis
34
Q

How is bleb associated endophthalmitis diagnosed?

A
  1. blebitis AND one of the following
  2. hypopyon
  3. anterior vitreous cells
  4. culture positive aqueous
  5. culture positive vitreous
35
Q

What is the posttreatment co-management procedure for SLT?

A
  1. 1 drop AlphaganP or Apraclonidine immediately following laser
  2. IOP checks at: 1-2 hours post-op, 1-2 days if high post-op IOP then 7-10 days* then 4-6 weeks, 3 months
  3. Many surgeons are now using lower powered energy pulse and using only an optional topical NSAID post op if needed for comfort
  4. Pred Forte use is only utilized for pronounced initial uveitic response or a uveitis that persists until 1 week post-op visit.

III. Glaucoma Management (9 decks)

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