Medical and Surgical Treatment of Primary Angle Closure Glaucoma

Primary angle closure glaucoma occurs when pathologies in the relative/absolute sizes or positions of anterior segment structures or abnormal forces in the posterior segment structures apply pressure on the peripheral iris, causing iridocorneal angle closure and trabecular outflow blockage. Careful evaluation of the clinical status at hospital admission, the exact diagnosis and the underlying physiopathologic mechanism is crucial in determining the correct treatment option for the individual. The initial approach should aim to lower intraocular pressure using medical treatment options. Laser treatments should be performed thereafter, to prevent further angle closure episodes. Surgery should be considered in patients where intraocular pressure is unresponsive to conventional medical and laser treatments. This study reviews the medical, laser and surgical treatments in primary angle closure glaucoma. (Turk J Ophthalmol 2012; 42: Supplement 1-7

Comparability of icare pro rebound tonometer with goldmann applanation and noncontact tonometer in a wide range of intraocular pressure and central corneal thickness

WOS: 000357766300005PubMed ID: 26022193Purpose: To evaluate the agreement between the reading values of the Goldmann applanation tonometer (GAT), Icare Pro rebound tonometer (IRT) and noncontact tonometer (NCT) in glaucoma patients. Methods: This cross-sectional study comprised 292 eyes of 292 patients selected from a glaucoma outpatient clinic. The intraocular pressure (IOP) was measured sequentially, at a 10-min interval each, in the following order: NCT, IRT and GAT. The central corneal thickness (CCT) was measured using Pentacam HR before the IOP measurements. Results: The mean IOPs measured by the GAT, NCT and IRT were 20.17 +/- 6.73 mm Hg (range: 4-48), 19.77 +/- 6.88 mm Hg (range: 3-46) and 19.30 +/- 5.15 mm Hg (range: 7.30-44.5), respectively. The correlation coefficients of the GAT and IRT, NCT and IRT, and GAT and NCT measurements were r(2) = 0.673, r(2) = 0.663 and r(2) = 0.938 (all p <0.001), respectively. The IRT tends to overestimate in the low GAT-measuredIOPs, whereas it underestimates in high GAT-measured IOPs. The measurements of all 3 devices were also correlated with the CCT at a statistically significant level (GAT: r(2) = 0.063, NCT: r(2) = 0.063, IRT: r(2) = 0.058). Conclusion: The agreement between the IRT and GAT measurements is higher in the IOP range of 9-22 mm Hg, whereas significant discrepancies occur as the IOP deviates from normal values. The variability of the IRT and GAT measurements over a wide range of CCT is minimal

Laser Applications on Iris for Treatment of Glaucoma

Laser applications on iris for the treatment of glaucoma include laser iridotomy (LI) and laser peripheral iridoplasty (LPI). LI is a simple and effective modality for treatment of closed-angle glaucoma with pupillary block. LPI is an easy and effective treatment for closed angle in situations in which LI either cannot be performed or does not repair the appositional angle closure because mechanisms other than pupillary block are present. The aim of this review is to summarize the indications, technique details, and complications of laser applications on iris for the treatment of glaucoma. (Turk J Ophthalmol 2013; 43: 190-4

Glokom Tedavisinde İrise Yönelik Lazer Uygulamaları

Laser applications on iris for the treatment of glaucoma include laser iridotomy (LI) and laser peripheral iridoplasty (LPI). LI is a simple and effective modality for treatment of closed-angle glaucoma with pupillary block. LPI is an easy and effective treatment for closed angle in situations in which LI either cannot be performed or does not repair the appositional angle closure because mechanisms other than pupillary block are present. The aim of this review is to summarize the indications, technique details, and complications of laser applications on iris for the treatment of glaucoma. (Turk J Ophthalmol 2013; 43: 190-4

Comparative Results of Viscotrabeculotomy and Classical Trabeculotomy in Congenital Glaucoma in a Longer-Term Follow-Up

Purpose: To evaluate the results of previously described viscotrabeculotomy technique and to compare them with those of conventional trabeculotomy in longer-term follow-up. Material and Method: This retrospective study included the eyes of 64 patients who underwent either viscotrabeculotomy (group 1) or conventional trabeculotomy (group 2) between February 1992 and April 2011. Group 1 consisted of 58 eyes of 34 patients who underwent viscotrabeculotomy surgery and group 2 consisted of 51 eyes of 30 patients who underwent conventional trabeculotomy. 3 patients (5 eyes) in group 1 and 2 patients (3 eyes) in group 2 left the follow-up for some reasons. At the last visit, group 1 comprised 53 eyes of 31 patients and group 2 comprised 48 eyes of 28 patients. Outcome measures were intraocular pressure (IOP), antiglaucomatous medications, horizontal corneal diameter, and success rate. Results: Success rates in group 1 at 12, 36, 60, 72, 96, 120 months, and at the last visit were 93.10%, 91.30% 89.30%, 87.00%, 84.90%, 83.00%, and 83.00%, respectively. The success rates in group 2 at the above-mentioned follow-up visits were 72.50%, 68.60%, 68.60%, 66.10%, 66.00%, 64.50%, and 62.50%, respectively. The success rate in group 1 was statistically significantly higher than in group 2 at the last visit (p=0.027). IOP and anti-glaucomatous medications at each follow-up examination were lower in group 1 compared to group 2, and these differences were with statistical significance (for each, p<0.05). Horizontal corneal diameters did not differ between the two groups in the postoperative follow-up. Discussion: Viscotrabeculotomy has been found safer and more effective than classical trabeculotomy in longer-term evaluation. Viscodissection of the trabecular meshwork, viscodilation of the Schlemm’s canal, keeping away the lips of trabeculotomy incision, and possibly prevention of postoperative hemorrhage and fibroblastic proliferation by means of high-viscosity sodium hyaluronate are the possible factors that play an important role in the overall success of this procedure. (Turk J Ophthalmol 2013; 43: 380-