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Angle Closure Glaucoma: Treatment01:28

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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Combining flanged intrascleral IOL fixation with Glaucoma Surgery: Initial experience.

Vanita Pathak-Ray1, Aashish K Bansal2,3, Varun Malhotra3

  • 1Department of Glaucoma, 80579Centre for Sight, Hyderabad, India.

European Journal of Ophthalmology
|December 13, 2021
PubMed
Summary

This study shows that combining flanged intrascleral intraocular lens (F-SFIOL) fixation with glaucoma surgery in a single stage is a promising approach. This combined procedure effectively controlled intraocular pressure and reduced medication needs with good visual outcomes.

Keywords:
Ahmed glaucoma valveFlanged intra-scleral IOL fixationaphakic glaucomadislocated crystalline lensmicrospherophakianeedlingsecondary angle closuretrabeculectomy

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Intraocular Lens Implantation

Background:

  • Glaucoma and the need for intraocular lens (IOL) implantation often coexist.
  • Traditional approaches may involve multiple surgical stages, increasing risks and costs.

Purpose of the Study:

  • To evaluate the initial clinical outcomes of a single-stage combined procedure involving glaucoma surgery and flanged intrascleral intraocular lens (F-SFIOL) fixation.
  • To assess the safety and efficacy of this novel combined surgical technique.

Main Methods:

  • Retrospective, non-comparative case series.
  • Inclusion of eyes undergoing combined glaucoma surgery and F-SFIOL with at least 6-month follow-up.
  • Procedures performed by a fellowship-trained senior glaucoma surgeon.

Main Results:

  • Twelve eyes of 10 patients underwent F-SFIOL, with 8 combined with glaucoma procedures (trabeculectomy, Ahmed Glaucoma Valve, or bleb needling).
  • Significant reduction in intraocular pressure (IOP) from 29.1 mmHg to 14.5 mmHg (p=0.006) and anti-glaucoma medication (AGM) use from 3.7 to 0.7 (p<0.001).
  • Best corrected visual acuity (BCVA) remained stable or improved in all eyes; one eye required IOL explantation.

Conclusions:

  • Single-stage F-SFIOL combined with glaucoma surgery is a promising initial approach.
  • This technique avoids the costs, specialized skills, and potential complications associated with posterior approaches.
  • This represents a novel, suture-less, flap-less, glue-less method for combined IOL fixation and glaucoma management.