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| Surgical treatment |
Glaucoma surgery is needed in patients who have a progressive visual field loss or optic nerve damage on maximal tolerable medical treatment. Indications for primary filtering surgery include:
1) Patients who are poor candidates for conventional medical treatment .
2) Patients in whom the target IOP is unlikely to be achieved with topical medications alone.
3) Visual field loss is such that further progression is likely to affect the patients quality of life
4) Patients with rapidly progressive glaucomatous optic neuropathy where quality of life would suffer unless rapid IOP lowering occurs to the desired target level.
Filtering surgery reduces the IOP and often eliminates the need for medical treatment. Although effective in 85 to 95% of previously unoperated eyes, the potential success of the operation must by measured against the potential effect of complications on the patient's quality of life
Although long-term control is often achieved with filtering surgery, many patients will require repeat surgery or supplemental medical management, or both. Glaucoma surgery combined with cataract extraction, may be indicated in patients who require visual rehabilitation with cataract extraction, in addition to IOP lowering.
Aqueous drainage devices are generally reserved as a last resort for patients with glaucoma that is refractory to standard filtering surgery. This includes patients with extensive conjunctival scarring, chronic inflammation, and ocular trauma. IOP lowering with glaucoma drainage devices is generally not as effective as with filtering surgery. Cyclophotocoagulation is another alternative for patients with glaucoma that is refractory to other interventions and where the visual potential is poor .
Excerpts from theinstruction course "Pearls To Increase The Surgical Outcome In Glaucoma " by Dr. Devindra Sood at the meeting organized by the Ophthalmic Society of Jaipur , Rajasthan, July 2008 |
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