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Normal Retinal Anatomy and Basic Pathologic Appearances

Normal Retinal Anatomy Commercially available spectral domain (SD-OCT) scanners have an Axial Resolution of between 4 µm and 7 µm and a transverse resolution of approximately 15 µm. Swept source (SS-OCT) devices, on the other hand, have an axial resolution between 6.3 µm and 8 µm and a transverse resolution of 20 µm. This high resolution allows for exquisite viewing of the retinal detail. Due to…

Artifacts on SD-OCT and OCTA

Artifacts can occur during image acquisition or analysis as a result of software, patient, or operator factors. It is important to identify artifacts because they may affect the qualitative or quantitative interpretation of images. This chapter will discuss artifacts that occur with spectral domain (SD)-OCT and OCT angiography (OCTA) scanning. OCT Artifacts Mirror Artifact ▶ Cause: This artifact occurs when the eye is positioned incorrectly or…

Basic Scan Patterns and OCT Output

Each commercially available OCT device uses unique scan patterns that are programmed into the machine. There is considerable overlap between devices, however, with several general scan patterns available across all devices. The scan patterns for the major commercially available machines are summarized in Table 1.2.1 . The two most commonly used scans in evaluating retinal disease are: ▶ Macular cube scan ▶ Line scan(s) Table 1.2.1…

New Glaucoma Surgical Alternatives

Summary There has been, in recent years, a considerable surge in interest in glaucoma surgery; techniques, devices, (implants), and procedures to warrant earnest attention and research. Several new devices (and implants) are currently being evaluated in clinical trials, all of which aspire to the common goal of achieving acceptable efficacy and limiting the potential for major vision-threatening complications. Ongoing research is constantly working on ways to…

Canaloplasty

Summary Canaloplasty provides a surgical means of safely lowering intraocular pressure in patients with open angles without depending on the function of a bleb or external drainage device. Working in the canal space provides a means of achieving moderate IOP control while avoiding many of the complications of traditional filtration surgery. Introduction The concept of lowering intraocular pressure by enhancing outflow by modifying the canal of…

The Ex-PRESS™ Miniature Glaucoma Implant

* Deceased. The editors and Elsevier note with sadness the untimely death of Elie Dahan who co-authored the first edition of this chapter. Summary The Ex-PRESS™ glaucoma implant is a miniature stainless steel device that offers a simple and safe alternative to the classic trabeculectomy. MPGS with the Ex-PRESS™ can be perceived as a standardized trabeculectomy because of the predetermined size of the implant lumen. The…

Trabectome ™

Summary The Trabectome procedure represents a minimally invasive trabecular bypass procedure with several years clinical experience. It has proven to be a safe surgical intervention with very low complication rates, but is paired with modest IOP lowering and is best suited to the early to moderate glaucoma patient. Compared to traditional filtering surgery, the Trabectome tends to have less pronounced IOP reduction, but far fewer complications.…

Complications of Cyclodestructive Procedures

Summary ▪ Cycloablation is an effective technique for controlling intraocular pressure in various forms of glaucoma. ▪ Transscleral diode laser cycloablation may lead to serious side effects that must be recognized by the treating physician. ▪ Transscleral cycloablation may be appropriate as first-line surgical treatment for certain patient populations. ▪ Endoscopic cyclophotocoagulation is a newer form of cycloablation that allows for targeted treatment of ciliary processes.…

Endophotocoagulation

Summary In summary, ECP should not be considered the same as transscleral forms of cycloablation, which are ‘blind’ procedures that can cause much collateral tissue damage and which can result in overtreatment or undertreatment of the tips of the ciliary processes. ECP may not be indicated for some cataract patients with very mild or very advanced glaucoma. However, it is a simple and easy addition to…