Surgical Options in Glaucoma Management

During the last few years, there has been a considerable capacity of innovations in glaucoma surgery owing to new micro-stents increasing the aqueous outflow via transscleral routes, via the trabecular meshwork or the suprachoroidal space. These interventions can be easily performed in combination with small-incision cataract surgery. Even the well-known filtering procedures, trabeculectomy and drainage device surgery, formerly perceived as being outdated, reachieve better reputation owing to refinements in surgical technique and improved surgical experience. Although enthusiasm is understandable, considering the technical advances, we must wait for clinical long-term results and compare the new procedures with the established ones

Surgical Options in Glaucoma Management

During the last few years, there has been a considerable capacity of innovations in glaucoma surgery owing to new micro-stents increasing the aqueous outflow via transscleral routes, via the trabecular meshwork or the suprachoroidal space. These interventions can be easily performed in combination with small-incision cataract surgery. Even the well-known filtering procedures, trabeculectomy and drainage device surgery, formerly perceived as being outdated, reachieve better reputation owing to refinements in surgical technique and improved surgical experience. Although enthusiasm is understandable, considering the technical advances, we must wait for clinical long-term results and compare the new procedures with the established ones

Application of rebound self-tonometry for measurements in a supine position

Background Diurnal or nocturnal fluctuations of intraocular pressure (IOP), which are especially common in glaucoma patients, often require hospitalization of the patient in order to be detected. This is often inconvenient for the patient. Therefore, this study evaluated the usefulness of a rebound tonometer (RT) designed for IOP self-tonometry (RT-Home) in an outpatient department, especially in the supine position and out of office hours. Methods Over a period of 6 months unselected open-angle glaucoma patients were equipped with a RT-home device for one night each. At the beginning IOP values measured by medical personnel (RT-Home(o)) were compared with IOP measured by the patient (RT-Home(p)), as well as measured by applanation tonometry according to Goldmann (GAT). Patients also completed a questionnaire regarding subjective comfort during use of the RT-Home. Results The RT-Home(o) showed a bias of -1.1mmHg (-7.9 to 5.7mmHg) compared to GAT and RT-Home(p) showed a bias of -1.6mmHg (-8.9 to 5.9mmHg) compared to GAT. The measurement differences between GAT and RT-Home(o) as well as RT-Home(p) showed a stong correlation with the IOP and the central corneal thickness (IOP: r= 0.481, P> 0.0001, RT-Home(o) vs. GAT; corneal thickness: r= 0.612, P< 0.0001, RT-Home(o) vs. GAT). The RT-Home(p) in a supine position showed significantly elevated IOP levels than during the day (P< 0.0001). The RT-Home showed no qualitative differences between measurements in supine and sitting positions. Discussion The RT-Home is effective and precise for use in an outpatient department to gain a general overview over patients' IOP out of office hours and also in the supine position. In the long term it seems possible that RT-Home can avoid hospitalization for diurnal and nocturnal IOP evaluation especially of young, mobile patients; however, interpretation of the data always requires professional knowledge

Trabeculectomy Using Mitomycin C versus an Atelocollagen Implant: Clinical Results of a Randomized Trial and Histopathologic Findings

Purpose: To assess the efficacy of trabeculectomy with a biodegradable Ologen (TM) implant (OLO) versus mitomycin C (MMC) in patients in a prospective randomized clinical trial. Methods: In the MMC group (15 patients), trabeculectomy was performed according to standard protocols. In the OLO group (15 patients) after standard trabeculectomy, the implant was positioned on top of the scleral flap, and no MMC was applied. Results: Mean preoperative intraocular pressure (IOP) levels (OLO: 28.0 +/- 9.4; MMC: 23.9 +/- 5.0 mm Hg; p = 0.21) and medication score (OLO: 3.4 +/- 1.6; MMC: 3.6 +/- 1.5; p = 0.56) were comparable in both groups. One year after surgery, the mean IOP was 15.9 +/- 4.5 mm Hg in the OLO group (p < 0.01, 43% reduction) and 11.0 +/- 2.6 mm Hg in the MMC group (p < 0.01, 54% reduction). The surgical success rate 12 months after surgery was 93.3% in the MMC group and 40% in the OLO group (p = 0.01). Conclusions: With the atelocollagen-glycosaminoglycan matrix OLO it was not possible to reach the surgical success rate and pressure reduction achieved in the MMC group. (C) 2013 S. Karger AG, Base

Reducing surface hazards and minimizing environmental disturbance at the Aurora-Guindon Mine in south eastern B.C.

There are numerous mine sites across Canada and throughout the world that are considered inactive. Falconbridge Limited (Falconbridge) has developed a method of property management to reclaim such sites. The process involves a property assessment with the objective of determining the best-fit reclamation solution based on social, technical and economical realities, which can then be implemented. This management tool has been proven as an effective method for the company, to meet the regulatory requirements for reclamation and closure. This approach to inactive property management was applied to the historic Aurora-Guindon mine. Lakefield Research Limited (LRL) conducted the site assessment on behalf of Falconbridge in 1995, characterizing waste dump materials and water quality. Based on this assessment, a reclamation proposal for the property was submitted to the BC Ministry of Energy and Mines (BCMEM) for approval. Reclamation work was conducted on the property in August of 1998, and two post-construction sampling events have taken place to monitor the effect on water quality. This paper and presentation will exhibit the cooperation between government, industry and consultants to determine the best reclamation option for an inactive property.Non UBCUnreviewedOthe

Accuracy of Measurements With the iCare HOME Rebound Tonometer

Purpose: To evaluate the accuracy of intraocular pressure (IOP) measurements obtained with the newly available iCare HOME (RTHOME) rebound tonometer compared with the iCare ONE (RTONE) tonometer and Goldmann applanation tonometry (GAT), and possible correlation with central corneal thickness (CCT). Materials and Methods: IOP measurements were obtained from 154 patients by an ophthalmologist (doc) using each of the above-mentioned tonometers. In addition, patients (pat) measured their own IOP with the RTHOME and RTONE. The means and SD of results obtained with the different tonometers were compared. Agreement between the tonometers was calculated using the Bland-Altman method. Results: Mean IOPs for the right eyes only were 15.9 +/- 6.4 mm Hg (RTONEdoc), 15.8 +/- 6.4 mm Hg (RTONEpat), 15.0 +/- 5.9 mm Hg (RTHOMEdoc), 14.9 +/- 6.3 mm Hg (RTHOMEpat), and 15.8 +/- 4.4 mm Hg (GAT). Bland-Altman analysis revealed mean differences (bias) between RTONEdoc and RTHOMEdoc, between RTHOMEdoc and RTHOMEpat, and between RTHOMEdoc and GAT of 0.8, 0.1, and -0.8 mm Hg, respectively, with 95% limits of agreement of -3.5 to 5.2, -4.9 to 5.1, and -7.2 to 5.6 mm Hg, respectively. Linear regression of the comparisons revealed a proportional error over the range of pressures examined in the case of RTHOMEdoc versus GAT (slope = 0.32, P < 0.001). Considering the data from all eyes, the difference between RTHOMEdoc and GAT correlated significantly with the CCT (P = 0.01). Conclusion: RTHOME readings correlate well with the GAT results although some limitations such as dependency of readings on CCT and increasing differences at lower and higher IOP levels need to be taken into account