Services Offered Glaucoma
The EX-PRESS® Glaucoma Filtration Device is among the most latest advances in glaucoma surgery in the past decade, providing a direct method of filtration for patients with open-angle glaucoma.
(PHOTO Glaucoma filtering device)
The World Health Organization (WHO) has estimated that 4.5 million people are blind due to glaucoma. Published projections indicate that 4.5 million people will be blind due to open-angle glaucoma and 3.9 million due to primary angle-closure glaucoma in 2010. Furthermore, about 60.5 million people will have glaucoma by the year 2010 (44.7 million with open-angle glaucoma and 15.7 million with angle-closure glaucoma). Given the aging of the world’s population, this number may increase to almost 80 million by 2020.
Primary open-angle glaucoma can be managed by long-term use of eye drops to reduce intraocular pressure or surgery (e.g , trabeculectomy) and should be followed up by long-term monitoring of the visual ﬁeld, optic disc, and intraocular pressure.
Medicinal and surgical treatments for glaucoma are addressing the global threat of glaucoma in an effort to bring about a significant reduction in the occurrence of preventable blindness throughout the world
PACHYMETER:-The thickness of the corneal correlates the measured pressures of the eye. We manage glaucoma with drops that lower this pressure. To be able accurately determine a patient’s current eye pressures; we need to have a pachymetry reading. This makes a pachymeter an essential tool for a practice managing glaucoma.
The PASCAL Dynamic Contour Tonometer is a revolutionary new digital tonometer that provides a direct trans-corneal measurement of intra-ocular pressure (IOP), and is sensitive enough to detect the ocular pulse amplitude (OPA) due to the patient's heartbeat.It does not get modified by corneal thickness unlike other tonometers.
The Humphrey visual field is a diagnostic device used to test a patient’s complete “visual field,” which includes the peripheral vision. It is a simple, painless, out-patient procedure and takes only minutes. It is based on automated perimetry, where repeated light stimuli of varying intensities appear in different parts of the field.
Fourier-domain optical coherence tomography (FD-OCT)(RTVue-100, Optovue Inc. ) has showed that the retinal nerve fiber layer (RNFL) is significantly thinner in glaucomatous eyes. However, there are significant differences in RNFL measurements between the two instruments, so they should not be used interchangeably.
The RTVue-100 is unique in its ability to measure the ganglion cell complex (GCC), compared with other FD-OCT instruments that are commercially available, and the GCC has also been found to be significantly thinner in glaucomatous eyes, making it potentially valuable for assessing patients with glaucoma .Measuring the macular thickness for assessing glaucoma is not a new idea.
Previous studies have measured the total macular thickness, a relatively insensitive parameter compared with measuring the inner retinal layers that are preferentially affected in glaucoma.
Glaucoma Treatment Paradigm
- Medical Therapy: - Prostaglandin Agonists, Beta Blockers Carbonic Anhydrase Inhibitors, Alpha Agonists
- Unlike conventional trabeculectomy, the EX-PRESS® Glaucoma Filtration Device does not require a sclerectomy or peripheral iridectomy. Rather, the device is implanted under the scleral flap.
- Implanted under a scleral flap
- Does not require a sclerectomy or peripheral iridectomy
- Unique flow-modulating design controls postoperative aqueous flow
Potential Benefits to Standard Trabeculectomy
- Management of intraocular pressure (IOP) at similar rates to trabeculectomy
- Lower rates of hypotony
- Lower rates of choroidal effusions
The EX-PRESS® Glaucoma Filtration Deviceis intended to reduce intraocular pressure in glaucoma patients where medical and conventional surgical treatments have failed.
In a clinical study, the EX-PRESS® Glaucoma Filtration Device had similar IOP-lowering efficacy to conventional trabeculectomy.
EX-PRESS® Glaucoma Filtration Device resulted in significantly less hypotony and choroidal effusion than trabeculectomy
The EX-PRESS® Glaucoma Filtration Device implanted under the scleral flap had similar IOP-lowering efficacy as compared to trabeculectomy.
Postoperative aqueous flow is controlled by its unique flow-modulating design and the scleral flap.
Does not require a sclerectomy or peripheral iridectomy.
The procedures—and the predictability factor
unlike conventional trabeculectomy, the EX-PRESS® Glaucoma Filtration Device does not require a sclerectomy or peripheral iridectomy. Rather, the device is implanted under the scleral flap.
Because the EX-PRESS® Glaucoma Filtration Device involves less surgical trauma, surgeons can potentially expect more rapid recovery than with the older procedure. And because the EX-PRESS® Glaucoma Filtration Device’s design provides controlled drainage, IOP is regulated, resulting in potentially less hypotony. In terms of both safety and efficacy, then, the EX-PRESS® Glaucoma Filtration Device offers surgeons potentially more predictability—and more peace of mind.
- Trabeculectomy is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by removing part of the eye's trabecular meshwork and adjacent structures. It is the most common glaucoma surgery performed and allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is absorbed
Postoperative Challenges of conventional glaucoma surgery (Trabeculectomy)
Phlebitis -If infectious can progress to devastating endophthalmitis
Hyphema:-Blood in Anterior chamber
Flat bleb - will fail if not formed in first postoperative days; if early scarring is cause, subconjunctival 5-FU injections can prevent conjunctiva from adhering down against wound bed
Bleb leak - may cause flat bleb; bandage contact lens for several days followed by leak repair if necessary
Flat anterior chamber - reform to prevent corneal decompensation ; can often be done in the office at the slit lamp with viscoelastics used in cataract surgery
Suprachoroidal hemorrhage - rupture of long posterior ciliary artery from progressive stretching with progressive serous choroidal detachment; usually occurs several days after trabeculectomy with acute pain often while straining
Hypotony - wound revision
Cataract formation - cataract surgery if visually significant
Small encapsulated bleb - injection of subconjunctival MMC and lidocaine can balloon up adjacent conjunctiva followed by needle incision of the bleb side and bleb extension.