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Angle Closure Glaucoma: Treatment01:28

Angle Closure Glaucoma: Treatment

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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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Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren...
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[The "Three Cherries Technique" for glaucoma drainage devices].

Constance Weber1, Ralf Brinken1, Frank G Holz1

  • 1Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53117, Bonn, Deutschland.

Die Ophthalmologie
|November 23, 2022
PubMed
Summary

A novel "three cherries technique" uses sutured sponges for precise mitomycin-C application during glaucoma surgery. This method enhances antimetabolite delivery and simplifies sponge retrieval, reducing surgical risks.

Keywords:
AntimetaboliteGlaucoma drainage implantGlaucoma surgeryMitomycin CTreatment refractory glaucoma

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Area of Science:

  • Ophthalmology
  • Surgical Techniques
  • Glaucoma Management

Context:

  • Filtering glaucoma surgery and glaucoma drainage implants carry a risk of fibrosis.
  • Posterior filtering bleb location poses challenges for sponge removal after antimetabolite application.
  • Dislocated sponges can complicate post-operative recovery and treatment efficacy.

Purpose:

  • To introduce and describe the novel "three cherries technique" for applying antimetabolites.
  • To minimize the risk of sponge dislocation and ensure complete sponge retrieval.
  • To enhance the safety and efficiency of mitomycin-C application in glaucoma surgery.

Summary:

  • The "three cherries technique" involves connecting three sponges with sutures for mitomycin-C application.
  • Each sponge is attached using a single button suture with 7.0 Vicryl thread.
  • Pulling the thread allows for quick and complete removal of all sponges post-application.

Impact:

  • Reduces the risk of sponge dislodgement and retention in the surgical site.
  • Ensures accurate and consistent delivery of antimetabolites to the target area.
  • Potentially improves surgical outcomes by mitigating fibrosis and complications in glaucoma surgery.