Tips and Techniques for Cataract Surgery in Glaucoma Patients
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ICO Guidelines for Glaucoma Eye Care
ICO Guidelines for Glaucoma Eye Care International Council of Ophthalmology Guidelines for Glaucoma Eye Care The International Council of Ophthalmology (ICO) Guidelines for Glaucoma Eye Care have been developed as a supportive and educational resource for ophthalmologists and eye care providers worldwide. The goal is to improve the quality of eye care for patients and to reduce the risk of vision loss from the most common forms of open and closed angle glaucoma around the world. Core requirements for the appropriate care of open and closed angle glaucoma have been summarized, and consider low and intermediate to high resource settings. This is the first edition of the ICO Guidelines for Glaucoma Eye Care (February 2016). They are designed to be a working document to be adapted for local use, and we hope that the Guidelines are easy to read and translate. 2015 Task Force for Glaucoma Eye Care Neeru Gupta, MD, PhD, MBA, Chairman Tin Aung, MBBS, PhD Nathan Congdon, MD Tanuj Dada, MD Fabian Lerner, MD Sola Olawoye, MD Serge Resnikoff, MD, PhD Ningli Wang, MD, PhD Richard Wormald, MD Acknowledgements We gratefully acknowledge Dr. Ivo Kocur, Medical Officer, Prevention of Blindness, World Health Organization (WHO), Geneva, Switzerland, for his invaluable input and participation in the discussions of the Task Force. We sincerely thank Professor Hugh Taylor, ICO President, Melbourne, Australia, for many helpful insights during the development of these Guidelines. International Council of Ophthalmology | Guidelines for Glaucoma Eye Care International -
Visual Outcomes of Combined Cataract Surgery and Minimally Invasive Glaucoma Surgery
1422 REVIEW/UPDATE Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery Steven R. Sarkisian Jr, MD, Nathan Radcliffe, MD, Paul Harasymowycz, MD, Steven Vold, MD, Thomas Patrianakos, MD, Amy Zhang, MD, Leon Herndon, MD, Jacob Brubaker, MD, Marlene Moster, MD, Brian Francis, MD, for the ASCRS Glaucoma Clinical Committee Minimally invasive glaucoma surgery (MIGS) has become a reliable on visual outcomes based on the literature and the experience of standard of care for the treatment of glaucoma when combined the ASCRS Glaucoma Clinical Committee. with cataract surgery. This review describes the MIGS procedures J Cataract Refract Surg 2020; 46:1422–1432 Copyright © 2020 Published currently combined with and without cataract surgery with a focus by Wolters Kluwer on behalf of ASCRS and ESCRS inimally invasive (sometimes referred to as mi- and thereby lower IOP. The endoscope consists of a fiber- croinvasive) glaucoma surgery (MIGS) is a pro- optic camera, light source, and laser aiming beam with an Mcedure that lowers intraocular pressure (IOP) 832 nm diode laser. The endoscope probe is introduced into without significantly altering the tissue, allows for rapid the globe via a limbal corneal or pars plana incision. The visual recovery, is moderately effective, and can be com- anterior approach requires inflation of the ciliary sulcus with bined with cataract surgery in a safe and efficient manner.1,2 an ophthalmic viscosurgical device, whereas the posterior This is in contrast to more conventional glaucoma surgery approach uses a pars plana or anterior chamber irrigation (eg, trabeculectomy or large glaucoma drainage device port. Although the anterior approach can be used in a phakic implantation), which requires conjunctival and scleral eye, it is typically performed with cataract extraction as a incisions as well as suturing. -
Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients
Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients Supported by an unrestricted educational grant from Ocular Surface Disease: Accurately Diagnose & Effectively Treat Your Surgical Patients Prevalence of Ocular Surface Disease and Its Impact on Surgical Outcomes Accurate diagnosis of dry eye disease is critical before cataract or refractive surgery By Elisabeth M. Messmer, MD ry eye is a common disease, but it may remain EPIDEMIOLOGY OF DRY EYE SYNDROME undetected. If it is not treated before cataract or 1-4 refractive surgery, patients may have suboptimal visual AFTER CATARACT SURGERY outcomes from their procedures. D l Very limited data available, mostly small descriptive/ IMPACT ON CATARACT SURGERY non-randomised studies There are a number of triggering factors for dry eye (Figure 1). l 10-20% of patients: DED induced or worsened after Cataract surgery worsens or causes dry eye in approximately uncomplicated cataract surgery 10% to 20% of patients (Figure 2).1-4 l In all studies: Signs and symptoms of dry eye In a study of 136 patients with a mean age of 71 years who increase after surgery were having cataract surgery, 22% had a prior diagnosis of dry eye that was not treated.5 Thirty-one percent complained l In most studies: gradual improvement of signs and of stinging, burning or other symptoms of dry eye when asked symptoms of dry eye within 3 months about their symptoms, and 41% reported a foreign body l In some studies: signs and symptoms persist > 3 months sensation. When the patients were examined, 77% had corneal staining and 50% had central staining. -
Documentation Dissection
Documentation Dissection Pre and Postoperative diagnosis: Uncontrolled moderate open angle glaucoma, left eye |1|. Procedure: Trabeculectomy of externo with peripheral iridectomy |2| Anesthesia: Conscious sedation, peribulbar block. Estimated blood loss: Less than 1 cc. COMPLICATIONS: None. The patient has had progressive visual field deterioration on maximum tolerated medications, and pressures in the high teens with a diagnosis of uncontrolled open angle glaucoma, left eye. To preserve her visual field, it was felt that surgery was necessarygiven the extensive damage to her optic nerve and field already existing |3|. The risks, benefits, and alternatives to surgery were discussed with the patient as well as with her husband, and she was anxious to proceed. PROCEDURE: The patient was brought to the operating room where she was given an intravenous sedative and peribulbar block. She was then prepped and draped in customary sterile fashion for intraocular surgery. A wire lid speculum was placed, and a 6-0 Vicryl traction suture was put through the superior peripheral cornea. The globe was retracted downward. The conjunctiva was entered 12 mm proximal to the limbus. With a combination of blunt and sharp dissection it was dissected down to the surgical limbus. The Gill’s knife was used to bare the limbus, and hemostasis was achieved with bipolar cautery |4|. A 4 x 4 mm rectangular lamellar flap was outlined with the 200 to 300 micron blade, |5| after which Mitomycin C 0.3 mg/cc was applied to the surface of the sclera overlying the outlying trap door for 2 minutes 30 seconds. The sponge and all instruments used to manipulate the Micomycin sponge were removed from the field, and the eye was vigorously irrigated with balanced salt solution (BSS). -
Presbyopia and Glaucoma: Two Diseases, One Pathophysiology? the 2017 Friedenwald Lecture
Lecture Presbyopia and Glaucoma: Two Diseases, One Pathophysiology? The 2017 Friedenwald Lecture Paul L. Kaufman,1 Elke Lutjen¨ Drecoll,2 and Mary Ann Croft1 1Department of Ophthalmology and Visual Sciences, Wisconsin National Primate Research Center, McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States 2Institute of Anatomy II, Erlangen, Germany Correspondence: Paul L. Kaufman, Department of Ophthalmology and Visual Sciences, University of Wisconsin Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-3220, USA; [email protected]. Citation: Kaufman PL, Lutjen¨ Drecoll E, Croft MA. Presbyopia and glaucoma: two diseases, one pathophysiology? The 2017 Friedenwald Lecture. Invest Ophthalmol Vis Sci. 2019;60:1801–1812. https://doi.org/10.1167/iovs.19-26899 resbyopia, the progressive loss of near focus as we age, is choroid and the retina stretch in parallel with each other during P the world’s most prevalent ocular affliction. Accommoda- the accommodative response. The question remains how far tive amplitude is at its maximum (~15 diopters) in the teen back the accommodative choroid/retina movement goes. years and declines fairly linearly thereafter (Fig. 1).1 By age 25 By ‘‘marking’’ points on retinal photographs (e.g., vascular about half the maximum accommodative amplitude has been bifurcations) in aphakic (to avoid lens magnification artifacts lost, by age 35 two-thirds are gone, and by the mid-40s all is during accommodation) monkey eyes, movement of the retina gone. Clinical symptoms usually begin at age ~40. The during accommodation can be quantified in terms of both accommodative apparatus of the rhesus monkey is very similar direction and magnitude (Fig. -
Cataract Surgery & Glaucoma
worldclasslasik.com http://www.worldclasslasik.com/cataract-surgery-new-jersey/cataract-surgery-glaucoma/ Cataract Surgery & Glaucoma The lens of your eye is responsible for focusing light on the objects you see. If the lens is clouded, then you can’t see things clearly, and this is known as a cataract. It can form gradually over many years or you can be born with a cataract. For some people, cataracts are not even noticeable. They just find themselves turning on more lights to read or having trouble with glares while driving at night. Most cataracts are problematic later in life. It is estimated that more than half of all Americans over the age of 80 will have cataracts or have had them corrected with surgery. Another common eye problem for seniors is glaucoma. Glaucoma is actually a group of eye diseases that affect the optic nerve by causing various types of damage due to high pressure. The optic nerve carries images from the retina to the brain, so advanced glaucoma can actually impair vision to the point of blindness. It is actually the leading cause of blindness in the world. However, glaucoma can be remedied in a number of ways. Early detection and treatment by your eye surgeon are critical in achieving optimal results. Resolve Cataracts and Glaucoma with Surgery While many adults over the age of 65 suffer from both cataracts and glaucoma, it is important to note that the two are not related. Glaucoma does not cause cataracts and cataracts do not cause glaucoma. That being said, cataract surgery involves creating a small incision in the lens of the eye to remove the affected, or “cloudy” area of the lens. -
Early Postoperative Rotational Stability and Its Related Factors of a Single-Piece Acrylic Toric Intraocular Lens
Eye (2020) 34:474–479 https://doi.org/10.1038/s41433-019-0521-0 ARTICLE Early Postoperative Rotational stability and its related factors of a single-piece acrylic toric intraocular lens 1,2 3 4 5 1 1 1 Shuyi Li ● Xi Li ● Suhong He ● Qianyin Zheng ● Xiang Chen ● Xingdi Wu ● Wen Xu Received: 30 November 2018 / Accepted: 18 June 2019 / Published online: 12 July 2019 © The Author(s) 2019. This article is published with open access Abstract Purpose In the present study, we aimed to evaluate the early postoperative rotational stability of TECNIS toric intraocular lens (IOL) and analyse its correlation with preoperative and intraoperative parameters. Methods A total of 102 eyes from 87 cataract patients who underwent implantation of TECNIS toric IOL during July 2016 to November 2017 were enrolled in this retrospective study. Preoperative parameters including corneal astigmatism, axial length (AL), lens thickness (LT), anterior chamber depth (ACD) and sulcus-to-sulcus (STS), were determined. The area of capsulorhexis was measured with Rhinoceros 5.0 software. The follow-up examinations including the residual astigmatism (RAS) and postoperative toric IOL axis, were performed at 1 month and 3 months after surgery. − − 1234567890();,: 1234567890();,: Results RAS was 0.84 ± 0.88 D at 1 month and 0.81 ± 0.89 D at 3 months after surgery. The rotation of toric IOL at 3 months was 4.83 ± 3.65°. The Pearson’s r of ACD, horizontal and vertical STS, and toric IOL target axis was 0.011, 0.039, 0.045 and 0.082. The toric IOL rotation was positively correlated with the area of capsulorhexis (r = 0.522, P = 0.0003), LT (r = 0.288, P = 0.003) and AL (r = 0.259, P = 0.009). -
CACI - Glaucoma Worksheet (Updated 04/26/2017)
CACI - Glaucoma Worksheet (Updated 04/26/2017) The Examiner must review a current status report by the treating physician and any supporting documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam. AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA Treating ophthalmologist finds the [ ] Yes condition stable on current regimen and no changes recommended. Age at diagnosis [ ] 40 or older FAA Form 8500-14 or equivalent [ ] Yes treating physician report that documents the considerations below: Acceptable types of glaucoma [ ] Open Angle being monitored and stable, Ocular Hypertension or Glaucoma Suspect being monitored and stable, or previous history of Narrow Angle/Angle Closure Glaucoma which has been treated with iridectomy /iridotomy (surgical or laser) and is currently stable. NOT acceptable: Normal Tension Glaucoma, secondary glaucoma due to inflammation, trauma, or the presence of any other significant eye pathology (e.g. neovascular glaucoma due to proliferative diabetic retinopathy or an ischemic central vein occlusion or uveitic glaucoma) Documented nerve damage or [ ] No trabeculectomy (filtration surgery) Medications [ ] None or Prostaglandin analogs (Xalatan, Lumigan, Travatan or Travatan Z), Carbonic anhydrase inhibitor (Trusopt and Azopt), Beta blockers (Timoptic, etc), or Alpha agonist (Alphagan). Combination eye drops are acceptable NOT acceptable for CACI: Pilocarpine or other miotics, cycloplegics (Atropine), or oral medications. Medication side effects [ ] None Intraocular pressure [ ] 23 mm Hg or less in both eyes ANY evidence of defect or reported [ ] No Unreliable Visual Fields Acceptable visual field tests: Humphrey 24-2 or 30-2 (either SITA or full threshold), Octopus (either TOP or full threshold). -
Medicare Quarterly Provider Compliance Newsletter Guidance to Address Billing Errors
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Quarterly Provider Compliance Newsletter Guidance to Address Billing Errors Updated Provider Index Now Available! See the Introduction section for more details Volume 3, Issue 4 - July 2013 ICN 908787/ July 2013 Table of Contents Comprehensive Error Rate Testing (CERT): Home Health Certification......................................................................... 1 CERT Finding: Glucose Monitoring Supplies .......................................... 3 CERT Finding: Inpatient Psychiatric Facility Prospective Payment System (PPS) ............................................................................ 5 Recovery Auditor Finding: Infusion Pump Denied/Accessories & Drug Codes Should Be Denied ............................................................. 7 Recovery Auditor Finding: Overutilization of Nebulizer Medications .... 8 Recovery Auditor Finding: Post-Acute Transfer - Underpayments ..... 10 Recovery Auditor Finding: Co-Surgery Not Billed with Modifier 62 .... 11 Recovery Auditor Finding: Pre-admission Diagnostic Testing Review ....................................................................................... 13 Recovery Auditor Finding: Duplicate Claims ...................................... 15 Recovery Auditor Finding: Add-on HCPCS/CPT Codes Without Primary Codes........................................................................... 17 Recovery Auditor Finding: Dose versus Units Billed - Bevacizumab (HCPCS J9035) and Rituximab -
Miotics in Closed-Angle Glaucoma
Brit. J. Ophthal. (I975) 59, 205 Br J Ophthalmol: first published as 10.1136/bjo.59.4.205 on 1 April 1975. Downloaded from Miotics in closed-angle glaucoma F. GANIAS AND R. MAPSTONE St. Paul's Eye Hospital, Liverpool The initial treatment of acute primary closed-angle Table i Dosage in Groups I, 2, and 3 glaucoma (CAG) is directed towards lowering intraocular pressure (IOP) to normal levels as Group Case no. Duration IOP Time rapidly as possible. To this end, aqueous inflow is (days) (mm. Hg) (hrs) reduced by a drug such as acetazolamide (Diamox), and aqueous outflow is increased via the trabecular I I 2 8 5 meshwork by opening the closed angle with miotics. 3 7 21 3 The use of miotics is of respectable lineage and hal- 5 '4 48 7 lowed by usage, but regimes vary from "intensive" 7 8 I4 5 9 I0 I8 6 (i.e. frequent) to "occasional" (i.e. infrequent) instilla- I I 2 12 6 tions. Finally, osmotic agents are used after a variable '3 5 20 6 interval of time if the IOP remains raised. Tlle pur- I5 '4 I8 6 pose of this paper is to investigate the value of '7 '4 i6 6 miotics in the initial treatment of CAG. I9 6 02 2 2 2 8 2I 5 Material and methods 4 20t 20 6 Twenty patients with acute primary closed-angle glau- 6 I i8 5 http://bjo.bmj.com/ coma were treated, alternately, in one of two ways 8 4 i8 5 detailed below: I0 6 I8 6 I2 I0 20 6 (I) Intravenous Diamox 500 mg. -
CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g. -
Drug Class Review Ophthalmic Cholinergic Agonists
Drug Class Review Ophthalmic Cholinergic Agonists 52:40.20 Miotics Acetylcholine (Miochol-E) Carbachol (Isopto Carbachol; Miostat) Pilocarpine (Isopto Carpine; Pilopine HS) Final Report November 2015 Review prepared by: Melissa Archer, PharmD, Clinical Pharmacist Carin Steinvoort, PharmD, Clinical Pharmacist Gary Oderda, PharmD, MPH, Professor University of Utah College of Pharmacy Copyright © 2015 by University of Utah College of Pharmacy Salt Lake City, Utah. All rights reserved. Table of Contents Executive Summary ......................................................................................................................... 3 Introduction .................................................................................................................................... 4 Table 1. Glaucoma Therapies ................................................................................................. 5 Table 2. Summary of Agents .................................................................................................. 6 Disease Overview ........................................................................................................................ 8 Table 3. Summary of Current Glaucoma Clinical Practice Guidelines ................................... 9 Pharmacology ............................................................................................................................... 10 Methods .......................................................................................................................................