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Cataract Surgery in Open-Angle Glaucoma

Summary Cataract will be entwined in the evolving ocular history of the patient with open-angle glaucoma. There is increasing scrutiny of the role of cataract surgery in the management of glaucoma, especially the timing of intervention. In angle closure the role of cataract surgery is becoming clarified, but in open-angle glaucoma the merit of cataract surgery needs to be considered in the context of many other…

Results of Nonpenetrating Glaucoma Surgery

Introduction A number of studies on nonpenetrating glaucoma surgery (NPGS) have been published in recent years. This is a fact to be celebrated, in view of the need for objective evaluations of these procedures in terms of efficacy, safety, and advantages in quality of life. Besides, these studies may be a means to adequately place this surgical option into the armamentarium of glaucoma. Not only the…

Postoperative Management of Nonpenetrating Glaucoma Surgery

Summary The first few postoperative weeks are crucial for the success of NPGS, as in the case of any other glaucoma surgical procedure. Utmost care, therefore, must be taken to follow-up the patient regularly, in order to detect, manage and treat complications as early as possible. The importance of life-long follow-up following glaucoma surgery cannot be over-emphasized. This chapter provides broad guidelines for follow-up protocols following…

Complications of Nonpenetrating Glaucoma Surgery

Summary As with any glaucoma surgery, patients should be told that unlike cataract surgery, nonpenetrating glaucoma surgery is neither a sight-improving operation nor is it a permanent cure for glaucoma. Follow-up continues to be essential. However, balance between safety and efficacy of properly made NPGS undoubtedly makes the learning efforts of this technique worthwhile. Introduction Nonpenetrating glaucoma surgery (NPGS) is now recognized as being associated with…

Viscocanalostomy

Summary Viscocanalostomy is an effective surgery for lowering IOP in glaucomatous eyes. It has several advantages over trabeculectomy, such as lower complication rate, lower incidence of cataract, less risk of infection-related side effects, fewer refractive changes, significantly less eye discomfort, and an easy postoperative management. When considering final IOPs between 16 and 21 mmHg, the rate of failure over time is similar between the two procedures, while…

Deep Sclerectomy

Summary Deep sclerectomy is a new nonpenetrating glaucoma surgery intended to lower the incidence of complications occurring after trabeculectomy. These complications essentially resulted from the early postoperative hypotony leading to a shallow anterior chamber, hyphema, choroidal hemorrhage and detachment, and increased risk of developing cataract. A good knowledge of the anterior segment anatomy and physiology is required to understand the principles underlying the deep sclerectomy technique.…

Principle and Mechanism of Function

Summary ▪ Nonpenetrating glaucoma surgeries include several different, but related, surgical techniques, including sinusotomy, ab externo or external trabeculectomy, deep sclerectomy with or without implants, and viscocanalostomy, all of which target the site of maximum outflow resistance. ▪ Aqueous egress occurs at the level of SC and its efferents, and the selective removal of the inner wall of Schlemm's canal and the adjacent trabecular meshwork results…

Future Strategies

Summary The Future: Total Scarring Control Significant advances have been made in developing new treatments and refining existing treatments for the prevention of scarring after disease, trauma, or surgical intervention. The advent of new technologies in addition to traditional chemical drugs such as dendrimers, nanoparticles, aptamers, ribozymes, gene therapy with viral vectors, and RNA interference, opens the door to a new generation of therapies to prevent…

Biological Drivers of Postoperative Scarring

Summary Regulation of wound healing following GFS is a complex process and involves multiple growth factors, cytokines, and proteases, and the TGF-β and CTGF systems appear to play major roles in promoting scarring and contraction that result in bleb failure. An ideal outcome of GFS is a diffuse, but healthy, bleb that filters aqueous humor without leaking. Achieving this goal is challenging, as the currently available…

Complications Associated with Modulation of Wound Healing in Glaucoma Surgery

[* Deceased. The editors and Elsevier note with sadness the untimely death of Francisco Fantes who co-authored the first edition of this chapter.] Summary Antifibrotic agents are extremely useful in lowering intraocular pressure in eyes unlikely to achieve success with standard trabeculectomy surgery. In order to attain and maintain lower pressures, the risk of hypotony and late infections has been increased. Physicians who augment their surgery…

Physical examination procedures

9.1 Blood pressure measurement Hypertension, the most common cause of mortality in the developed world, is a major contributing factor in stroke, myocardial infarction, coronary artery disease, heart failure, abdominal aortic aneurysm, and peripheral arterial disease. , Hypertension affects about 25% of adults and over 50% of people aged 65 and older in Canada and the United Kingdom and over 60 million Americans, with varying prevalence…

Variations in appearance of the normal eye

The vast majority of patients examined in optometry practice have normal, healthy eyes. This chapter presents information about some of the subtle variations that occur in the normal eye and presents changes that commonly occur with normal ageing. To discriminate between ocular disease and the normal eye, it is essential to be familiar with the range of presentations that is considered to represent ‘normal.’ A brief…

Ocular health assessment

7.1 Examination of the anterior segment and ocular adnexa This includes the eyelids, eyelashes, conjunctiva, tear layer, cornea, anterior chamber, iris, crystalline lens, and anterior vitreous. 7.1.1 The evidence base: When and how to assess the anterior segment and adnexa This is typically performed during most full oculo-visual assessments and contact lens assessments and some partial oculo-visual assessments, plus before and after any procedure that touches…

Assessment of binocular vision and accommodation

Tests of accommodation and binocular vision are presented together in this chapter because, from a problem-oriented examination viewpoint, it is frequently not obvious whether a patient’s signs and symptoms are primarily accommodative or binocular in origin. Core or ‘entrance’ tests act as screening tests in patients without symptoms that suggest a binocular vision or accommodative problem and are performed after the case history and before refraction.…

Contact lens assessment

Patient preference for contact lenses over glasses is common owing to perceived conveniences (i.e., no spectacle fogging, can see better in rain, can wear off-the-shelf sunglasses) as well as improvements in appearance and abilities in sports. There is a relatively high discontinuation of contact lens wear (∼16% United States, ∼30% Europe), , but patients are more likely to succeed when fitted with lenses that suit their…

Refraction and prescribing

4.1 Focimetry (vertometry or lensometry) The instrument used to measure lens power , optical centres, and any prism in glasses has been known by a variety of trade names including refractionometer, dioptrescope, and ultimeter, but currently the most commonly used names in different parts of the world are focimeter, vertometer, lensmeter, and lensometer. 4.1.1 The evidence base: When and how to assess lens powers and optical…

Assessment of visual function

3.1 Distance visual acuity Visual acuity (VA), which is a measure of the patient’s ability to resolve fine detail, is the most commonly used measurement of visual function. Distance and reading VAs are used to assess the adequacy of glasses or contact lenses and as a key indicator of ocular health. Distance VA is also used to assess a person’s fitness to drive or enter into…

Communication skills

2.1 Turning anxious patients into satisfied ones 2.1.1 Patient satisfaction is linked to good communication skills The research literature consistently indicates that patient satisfaction is linked with clinicians having good communication skills: being able to explain diagnoses, prognoses, treatment, and prevention using clear, non-technical terms and being honest, empathic, and able to listen well and address patient concerns. Good communicators are popular with their patients, and…

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Laryngeal and Esophageal Trauma

Key Points 1. Laryngeal fractures are uncommon injuries that may be associated with life-threatening airway compromise. 2. The first and most important step in the management of laryngeal trauma is to verify and secure a safe airway. 3. Esophagoscopy should be performed in any patient going to the operating room to rule out concomitant injury. 4. The most common cause of internal laryngeal trauma is endotracheal…