DOCSLIB.ORG

Management of Patients with Combined Glaucoma and Corneal

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Patients with Combined Glaucoma and Corneal Eye (2009) 23, 1972–1979 & 2009 Macmillan Publishers Limited All rights reserved 0950-222X/09 $32.00 www.nature.com/eye CAMBRIDGE OPHTHALMOLOGY SYMPOSIUM Management of M Banitt and RK Lee patients with combined glaucoma and corneal transplant surgery Abstract Trends in corneal transplant surgery Penetrating keratoplasty (PKP) is associated In clinical series from around the world, with an increased risk of secondary glaucoma. primary indications for PKP include visually The development of glaucoma after PKP is an significant corneal scarring secondary to important risk factor for decreased corneal keratoconus and bullous keratopathy.1–10 An graft survival. The incidence of glaucoma after important trend associated with improvements corneal transplant as well as the mechanism of in cataract surgery techniques and the developing increased intraocular pressure is introduction of intraocular lenses has been a reviewed in this paper. Treatments for post- decline in aphakic bullous keratopathy (ABK) PKP glaucoma include medications, laser, and and an increase in pseudophakic bullous surgery. The most frequent surgical glaucoma keratopathy (PBK).8,11–14 After cataract surgery intervention is implantation of a glaucoma- techniques evolved and phacoemulsification drainage device. Recent advances in corneal technology improved in the 1990s, transplantation surgery may help to decrease pseudophakic corneal oedema rates have corneal failure and the risk of developing decreased.5–8,11,14–16 post-keratoplasty glaucoma. Descemet stripping automated endothelial Bascom Palmer Eye Institute, Eye (2009) 23, 1972–1979; doi:10.1038/eye.2008.377; keratoplasty (DSAEK) is a significant change in University of Miami School published online 16 January 2009 the approach to corneal transplantation of Medicine, Miami, FL, USA involving the transplantation of an endothelial Keywords: glaucoma; corneal transplant; cell layer (with a thin stromal layer) vs a full Correspondence: RK Lee, surgery thickness corneal graft in PKP. DSAEK has Bascom Palmer Eye Institute, University of Miami School rapidly replaced PKP as the preferred method of Medicine, 900 NW 17th Introduction of corneal transplantation in eyes with PBK and Street, Fuchs’ corneal dystrophy. The Eye Bank Miami, FL 33136, USA Advances in keratoplasty surgical techniques Association of America reported an increase in Tel: 1 305 547 3686; þ may help to decrease the incidence of secondary corneal transplants from 48 298 to 50 122 from Fax: þ 1 305 547 3658; glaucoma after keratoplasty surgery. The 2005 to 2007. In this same time period, the E-mail: rlee@ development of glaucoma after penetrating med.miami.edu number of corneal endothelial transplant keratoplasty (PKP) can lead to devastating long- surgeries increased exponentially from 1429 to Received: 27 October 2008 term complications, which are often sight 14 159.17 Accepted in revised form: threatening and challenging to treat. Patients 5 November 2008 with glaucoma after corneal transplants often Published online: 16 January respond poorly to medications and laser Increased incidence of glaucoma after 2009 treatment and require surgical intervention not penetrating keratoplasty The authors have no only to lower the intraocular pressure and proprietary or financial preserve the optic nerve, but also to improve the Irvine and Kaufman first reported a higher interest in the work survival of the corneal graft. This paper reviews incidence of elevated IOP after PKP noting discussed in this paper. the incidence, mechanism, and treatment of intraocular pressures higher than 25 mmHg in RK Lee is supported by NIH secondary glaucoma associated with corneal 37% of phakic eyes and 88% in aphakic eyes grant EY016775 and the American Health Assistance transplantation. Current trends in corneal during the first post-operative week after 18 Foundation – Glaucoma transplantation and glaucoma surgery are also corneal transplant surgery. The incidence of Research Foundation. discussed. glaucoma after PKP varies with the indication Glaucoma and corneal transplant surgery M Banitt and RK Lee 1973 for PKP. Increased IOP develops most frequently after rejection, but may lead to steroid response glaucoma in PKP for ABK and less frequently for eyes with Fuchs’ susceptible patients. corneal dystrophy and keratoconus.19–27 In a series of 502 corneal transplant patients reported by Foulks in 1987, glaucoma developed in 18% of all patients studied: 39% Medical management of post-keratoplasty glaucoma in patients who were aphakic, 8% in patients who had no Topical medications should be used with full awareness history of glaucoma, and 80% in patients who had a prior of their inherent risks and benefits in mind. Most topical 19 history of glaucoma. In a series of 1122 patients from medications have preservatives, which can lead to 23 1992, Kirkness and Ficker reported that 1% of patients punctate epithelialopathy. Timolol is currently with keratoconus, 3% of patients with corneal manufactured in a non-preserved formulation. dystrophies, and 29% of patients with bullous Briminodine is preserved with Purites and travoprost keratopathy developed elevated IOP following PKP. In has a formulation preserved with Sofzias instead of 1998, Ing reported the risk of developing glaucoma post- benzalkonium chloride. PKP was 21% in this surgical series of 394 patients: 1% in The most commonly used and successful glaucoma patients with keratoconus and up to 44% in patients with medications are topical beta-blockers and alpha- 21 PBK. adrenergic agonists. Prostaglandins are effective in Other risk factors for the development of glaucoma lowering the IOP, but case reports of increased incidence after PKP include pre-existing glaucoma, the presence of of inflammation associated with their use may peripheral anterior synechiae, corneal re-grafting, a compromise graft outcome and visual outcome if cystoid history of ocular trauma, and combined PKP and cataract macular oedema develops. Prostaglandin agonists 19,21–23,28,29 extraction surgery. Simmons reported a should also be used with caution in patients with a fourfold increased relative risk for developing glaucoma history of herpetic disease as Wand reported an post-keratoplasty in patients with pre-existing glaucoma association between latanoprost and recurrence of 30 vs those without a prior history of glaucoma. Sihota herpetic keratitis.36 We do not hesitate to use reported a post-keratoplasty incidence of glaucoma of prostaglandin agonists in patients with post-keratoplasty 10.6% in his series of 747 patients, 13% of whom glaucoma, especially if the alternative is surgical 31 underwent repeat PK for a failed corneal graft. intervention. The use of miotics is usually ineffective and not Mechanisms of post-keratoplasty glaucoma recommended in the early post-operative period as pilocarpine causes break-down of the blood–aqueous Although increased IOP after PKP can develop in eyes barrier and shallows the anterior chamber with with open or closed angles, peripheral anterior synchiae subsequent intraocular inflammation and potential 23,28 is present in 87% of patients post-PKP. Distortion of development of peripheral anterior synchiae. Carbonic the angle, anterior and posterior to the trabecular anhydrase inhibitors (CAIs) can be used topically or meshwork, has also been implicated as a cause for systemically. Although carbonic anhydrase enzyme is increased IOP after PKP. Anterior to the angle, tight and expressed by the corneal endothelium and is associated long sutures cause distortion, which leads to corneal with endothelial pump function, the effect of CAIs on the oedema and distortion of the trabecular meshwork. graft is likely to be clinically significant only if the graft is Posterior to the angle, loss of fixation normally afforded near failure.37,38 by the ciliary body-lens-support system allows for collapse of the TM.32,33 In our experience, peripheral anterior synechiae secondary to corneal transplantation Surgical management of post-keratoplasty glaucoma leads to progressive angle closure glaucoma that is often Cyclodestructive procedures difficult to treat with medications or laser and frequently requires surgical intervention for adequate IOP control. Cyclodestruction was the first attempted surgical Corneal transplant donor size may also affect post- treatment for post-keratoplasty glaucoma. By ablating a keratoplasty IOP. Using oversized donor tissue may portion of the ciliary body, IOP is lowered by decreasing decrease the incidence of increased IOP after PKP in the aqueous humour production. Destruction of the ciliary early post-operative course and, possibly in the long body can be achieved through transscleral application of term, but data supporting this is limited.32–35 Post- cryotherapy or transscleral or endoscopic delivery of surgical glaucoma can be caused by pupillary block, diode, krypton or neodymium:yttrium–aluminum– iritis, haemorrhage, steroid response, malignant garnet (Nd:YAG) laser. glaucoma, or retained viscoelastic. The use of steroids is Treatment success, defined as an IOP of less than often a double-edged sword as it is used to prevent graft 21 mmHg after a single application of laser, has recently Eye Glaucoma and corneal transplant surgery M Banitt and RK Lee 1974 been reported to be between 63–97%.39–44 However, 50% (12 of 24 eyes) after 2 years of follow-up based on multiple treatments may be necessary and graft failure various small studies.46,51 Graft clarity has been reported rates have been reported to
Load more

Recommended publications
  • 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.
    [Show full text]
  • Ocular Surface Changes Associated with Ophthalmic Surgery
    Journal of Clinical Medicine Review Ocular Surface Changes Associated with Ophthalmic Surgery Lina Mikalauskiene 1, Andrzej Grzybowski 2,3 and Reda Zemaitiene 1,* 1 Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania; [email protected] 2 Department of Ophthalmology, University of Warmia and Mazury, 10719 Olsztyn, Poland; [email protected] 3 Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61553 Poznan, Poland * Correspondence: [email protected] Abstract: Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combina- tion with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface. Keywords: dry eye disease; ocular surface dysfunction; cataract surgery; phacoemulsification; refractive surgery; trabeculectomy; vitrectomy Citation: Mikalauskiene, L.; Grzybowski, A.; Zemaitiene, R. Ocular Surface Changes Associated with Ophthalmic Surgery. J. Clin. 1. Introduction Med. 2021, 10, 1642. https://doi.org/ 10.3390/jcm10081642 Dry eye disease (DED) is a common condition, which usually causes discomfort, but it can also be an origin of ocular pain and visual disturbances.
    [Show full text]
  • 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).
    [Show full text]
  • Glaucoma Book-4.8.19.Pdf
    Save time at your check-in and register online before your appointment! It’s as easy as 1-2-3 1. Go online to www.blackhillseyes.com 2. Click this logo on our home page for the link to register: 3. Set-up a secure online account by completing the questionnaire. Completion of your online registration will allow you to send us a secure email message. You will now be able to view your medical record online. Setting up this account will allow you to send secure email messaging to submit follow-up questions, medicine changes, or post-op questions to your doctor. It’s secure and convenient and available 24/7. Questions about your portal account, call 605-719-3218 Phone Number Any patient requiring assistance 605-341-2000 transferring will need to be accompanied by someone who Toll Free Number can aid in that transfer. 1-800-658-3500 Drop off and pick up area All Phones Are available near front entrance. Answered 24 Hours A Day Wheelchairs also available at front entrance. 2800 Third Street Rapid City, SD 57701 Just East of Rapid City Regional Hospital GLAUCOMA EVALUATION APPOINTMENT Black Hills Regional Eye Institute Doctor: Phone: 605-341-2000 DOCTOR ____________________________________________________________________________ CONTACT ___________________________________________________________________________ EVALUATION APPOINTMENT __________________________________________________________ Surgery or laser treatment may be scheduled after this evaluation appointment. You will not have surgery on your first appointment with the Black Hills Regional Eye Institute. Your evaluation appointment will be 2-3 hours long. You will be evaluated by our surgeon, our staff will perform several tests and your eyes will be dilated.
    [Show full text]
  • Efficacy, Safety, and Survival Rates of IOP-Lowering Effect of Phacoemulsification Alone Or Combined with Canaloplasty in Glaucoma Patients
    ORIGINAL STUDY Efficacy, Safety, and Survival Rates of IOP-lowering Effect of Phacoemulsification Alone or Combined With Canaloplasty in Glaucoma Patients Stella N. Arthur, MD, MSPH,*w Louis B. Cantor, MD,* Darrell WuDunn, MD, PhD,* Guruprasad R. Pattar, MD,* Yara Catoira-Boyle, MD,* Linda S. Morgan, CCRC, COA,* and Joni S. Hoop, CCRC, COA* Conclusions: A combination of canaloplasty with phaco results in a Purpose: To evaluate efficacy and survival rates of intraocular decreased number of glaucoma medications and increased survival pressure (IOP)-lowering effect obtained with phacoemulsification rate of IOP-lowering effect compared with phaco alone. (phaco) alone or in combination with canaloplasty (PCP) in patients with open-angle glaucoma (OAG). Key Words: phacoemulsification, canaloplasty, glaucoma Methods: Retrospective chart review of consecutive cases at the (J Glaucoma 2013;00:000–000) Department of Ophthalmology, Indiana University. Visual acuity (VA), IOP, number of medications (Meds), failures, and survival rates of IOP-lowering effect were analyzed. Inclusion criteria were: patients older than 18 years with OAG and cataract. Exclusion umerous studies demonstrate that phacoemulsification criteria were: no light perception vision, prior glaucoma surgery, N(phaco) may produce long-term reduction of intra- 1,2 chronic uveitis, angle-closure glaucoma, and advanced-stage or ocular pressure (IOP) in subjects without glaucoma, end-stage OAG. Failure criteria were: IOP > 21 mm Hg or <20% patients with pseudoexfoliation syndrome,3,4 or glaucoma reduction, IOP < 6 mm Hg, further glaucoma surgeries, and loss of patients.5–8 The effect is thought to be mediated by 3 major light perception vision. mechanisms: hyposecretion of aqueous humor due to Results: Thirty-seven patients underwent phaco and 32 patients had production of free radicals or partial ciliary body detach- PCP.
    [Show full text]
  • Trabeculectomy Bleb Assessment Via Three-Dimensional Anterior Segment Optical Coherence Tomography
    Central JSM Ophthalmology Research Article *Corresponding author Takahiro Kawaji, Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Trabeculectomy Bleb Honjo, Chuo-ku, Kumamoto 860-8556, Japan, Tel: +81-96-373-5247; Fax: +81-96-373-5249; Email: Assessment via Three- Submitted: 23 February 2014 Accepted: 03 March 2014 dimensional Anterior Segment Published: 07 March 2014 ISSN: 2333-6447 Optical Coherence Tomography Copyright Takahiro Kawaji*, Toshihiro Inoue, Riyo Matsumura, Utako © 2014 Kawaji et al. Kuroda, Kei-Ichi Nakashima and Hidenobu Tanihara OPEN ACCESS Department of Ophthalmology, Kumamoto University, Japan Keywords Abstract • Glaucoma • Trabeculectomy Background: To evaluate the morphological features of filtering blebs after • Bleb trabeculectomy by using three-dimensional anterior segment optical coherence • Three-dimensional anterior segment optical tomography (3D AS-OCT). coherence tomography Methods: This retrospective cross-sectional study evaluated 47 patients who had undergone trabeculectomy with mitomycin C. All blebs were imaged with 3D AS-OCT and analyzed with our custom software. We assessed blebs quantitatively for the following features: bleb height, fluid-filled cavity height, bleb wall thickness, and bleb wall intensity. Results: The mean (± standard deviation [SD]) time period between trabeculectomy and 3D AS-OCT measurement was 9.5 ± 6.2 months; the mean (±SD) intraocular pressure (IOP) measured 14.0 ± 4.3 mm Hg at the time of 3D AS-OCT imaging. IOP and the bleb height (rs = -0.609, P = < .0001), the fluid-filled cavity height (rs = -0.381, P = 0.009), the bleb wall thickness (rs = -0.503, P = 0.0004) and the bleb wall intensity (rs = 0.612, P = < .0001) showed statistically significant correlations.
    [Show full text]
  • Laser Trabeculoplasty for Open-Angle Glaucoma a Report by the American Academy of Ophthalmology
    Laser Trabeculoplasty for Open-Angle Glaucoma A Report by the American Academy of Ophthalmology John R. Samples, MD,1 Kuldev Singh, MD, MPH,2 Shan C. Lin, MD,3 Brian A. Francis, MD,4 Elizabeth Hodapp, MD,5 Henry D. Jampel, MD, MHS,6 Scott D. Smith, MD, MPH7 Objective: To provide an evidence-based summary of the outcomes, repeatability, and safety of laser trabeculoplasty for open-angle glaucoma. Methods: A search of the peer-reviewed literature in the PubMed and the Cochrane Library databases was conducted in June 2008 and was last repeated in March 2010 with no date or language restrictions. The search yielded 637 unique citations, of which 145 were considered to be of possible clinical relevance for further review and were included in the evidence analysis. Results: Level I evidence indicates an acceptable long-term efficacy of initial argon laser trabeculoplasty for open-angle glaucoma compared with initial medical treatment. Among the remaining studies, level II evidence supports the efficacy of selective laser trabeculoplasty for lowering intraocular pressure for patients with open-angle glaucoma. Level III evidence supports the efficacy of repeat use of laser trabeculoplasty. Conclusions: Laser trabeculoplasty is successful in lowering intraocular pressure for patients with open- angle glaucoma. At this time, there is no literature establishing the superiority of any particular form of laser trabeculoplasty. The theories of action of laser trabeculoplasty are not elucidated fully. Further research into the differences among the lasers used in trabeculoplasty, the repeatability of the procedure, and techniques of treatment is necessary. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
    [Show full text]
  • Effect of Trabeculotomy on Corneal Endothelial Cell Loss in Cases of After Penetrating-Keratoplasty Glaucoma
    CLINICAL SCIENCE Effect of Trabeculotomy on Corneal Endothelial Cell Loss in Cases of After Penetrating-Keratoplasty Glaucoma Ayaka Kusakabe, BS, MS,* Naoki Okumura, MD, PhD,* Koichi Wakimasu, MD,† Kanae Kayukawa, MD,† Masami Kondo, BS,* Noriko Koizumi, MD, PhD,* Chie Sotozono, MD, PhD,‡ Shigeru Kinoshita, MD, PhD,†‡§ and Kazuhiko Mori, MD, PhD‡ laucoma is recognized as one of the most devastating Purpose: The aim of this study was to evaluate the effect of Gcomplications that can arise after corneal transplantation, trabeculotomy (TLO) on glaucoma and endothelial cell loss after as it can often lead to corneal graft failure and glaucomatous penetrating keratoplasty (PK). optic neuropathy resulting in visual field loss. In 1969, Irvine 1 Methods: A retrospective study was conducted on consecutive patients and Kaufman reported a high incidence of intraocular who underwent PK and in whom more than 24 months of follow-up was pressure (IOP) elevation after penetrating keratoplasty (PK). available. Patients were categorized into the PK+TLO group [ie, TLO for Currently, it is widely accepted that the incidence of post-PK glaucoma (n = 10)] and the PK group [PK alone (n = 73)]. glaucoma after PK is high, ranging from 9% to 35% of all cases.2–8 Intraocular pressure (IOP) was evaluated during each follow-up fi examination. Central corneal endothelium images were obtained and Topical administration of antiglaucoma drugs is a rst- analyzed to determine corneal endothelial cell (CEC) density. line treatment for the control of IOP. However, as manage- ment of glaucoma after corneal transplantation is difficult, Results: The mean duration period from original PK to TLO for surgical treatments are often required.8 Trabeculectomy secondary glaucoma was 25.5 6 34.9 months in the PK+TLO group.
    [Show full text]
  • Glaucoma Management After Corneal Transplantation Surgeries
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Curr Opin Manuscript Author Ophthalmol. Manuscript Author manuscript; available in PMC 2017 September 05. Published in final edited form as: Curr Opin Ophthalmol. 2016 March ; 27(2): 132–139. doi:10.1097/ICU.0000000000000237. Glaucoma management after corneal transplantation surgeries Helen L. Kornmann and Steven J. Gedde Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA Abstract Purpose of review—Intraocular pressure (IOP) elevation and glaucoma progression following corneal transplantation, specifically, penetrating keratoplasty, Descemet’s stripping endothelial keratoplasty, and Boston keratoprosthesis, are well described causes of ocular morbidity. Depending on the procedure performed, the incidence of glaucoma is highly variable. Several etiologic factors have been identified, the most common being synechial angle closure and corticosteroid-induced IOP elevation. The purpose of this review is to describe the various treatment strategies for glaucoma following corneal transplantation. Recent findings—Medications and laser treatments are usually first-line therapies for postoperative IOP elevation. Surgical intervention, including filtering surgery and glaucoma drainage devices, may be necessary to control IOP and prevent progressive glaucomatous damage. Summary—Glaucoma is a common complication of corneal transplantation, and the degree of aggressiveness is often related to the indication for corneal surgery.
    [Show full text]
  • Medicare and Coding Issues
    3/6/2014 What Ophthalmologists Presented by Joy Newby, LPN, CPC, PCS Need to Know About Newby Consulting, Inc. Medicare and Coding 5725 Park Plaza Court Indianapolis, IN 46220 Illinois Society of Eye Physicians and Surgeons Voice: 317.573.3960 Chicago Ophthalmological Society Fax: 866-631-9310 Annual Joint Meeting March 7, 2014 E-mail: [email protected] This presentation was current at the time it was published and is intended to provide useful information in regard to the subject Agenda matter covered. Newby Consulting, Inc. believes the information is as authoritative and accurate as is reasonably possible and that the sources of information used in preparation of the manual are reliable, but no assurance or warranty of completeness or accuracy is intended or given, and all warranties of any type are disclaimed. • ICD-10 - Are we close to being ready? The information contained in this presentation is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Any five-digit numeric Physician's Current Procedural Terminology, Fourth Edition (CPT) codes service descriptions, instructions, and/or guidelines are copyright 2013 (or such other date of publication of CPT as defined in the federal copyright laws) American Medical Association. 4 International Classification of Diseases, International Classification of Diseases, Tenth Tenth Revision (ICD-10) Revision, Clinical Modification (ICD-10-CM)
    [Show full text]
  • Primary Open Angle Glaucoma and Post-LASIK Keratectasia
    Challenging Case Primary Open Angle Glaucoma and Post-LASIK Keratectasia Section Editor: Mohammad Pakravan, MD mmHg in the right and left eyes respectively CASE PRESENTATION while receiving latanoprost (once daily), timolol The patient presented herein is a 52-year-old (twice daily) and dorzolamide (twice daily) woman suffering from primary open angle in both eyes. Central corneal thickness (CCT) glaucoma (POAG) in both eyes. She has no measured 431 and 322 microns in her right history of systemic disorders and is not on any and left eyes respectively. Fundus examination systemic medications. She underwent laser in situ revealed average-sized discs with vertical cup keratomileusis (LASIK) 9 years ago for refractive to disc ratios of 0.9 and 0.8 in the right and left error of -5.50-3.00×180 in both eyes, and was eyes respectively, together with inferior rim diagnosed with glaucoma 7 years afterwards. loss; the macula, vessels and periphery were Her ocular examination when I saw her for the unremarkable. Baseline automated perimetry first time two years ago was as follows. (Humphrey Field Analyzer II, Humphrey Best corrected visual acuity (BCVA) was Systems, Carl Zeiss Meditec Inc., Dublin, USA) 6/10 and 3/10 in the right and left eyes with is shown in figure 2. -4.00-1.00×30 and -13.00-5.50×180 respectively Considering that target IOP had been while wearing rigid gas permeable (RGP) contact achieved, I suggested that she be followed lenses. Slitlamp examination revealed a LASIK closely with medications. She was observed flap and signs of corneal ectasia in the left eye, for two years, but on her last examination I mild nuclear sclerosis changes were evident noticed suspicious progression of cupping and in both eyes and other slitlamp findings were visual field defects especially in her left eye.
    [Show full text]
  • Five-Year Outcomes of Trabeculectomy and Phacotrabeculectomy
    Open Access Original Article DOI: 10.7759/cureus.12950 Five-Year Outcomes of Trabeculectomy and Phacotrabeculectomy Danny Lam 1 , David Z. Wechsler 1, 2 1. Ophthalmology, University of Sydney, Sydney, AUS 2. Ophthalmology, Macquarie University, Sydney, AUS Corresponding author: Danny Lam, [email protected] Abstract Purpose The purpose of this study is to examine five-year outcomes of trabeculectomy and compare the stand-alone procedure when combined with phacoemulsification. Patients and methods This study included 123 eyes of 109 patients, with 79 patients in the trabeculectomy group and 44 patients in the phacotrabeculectomy group. Non-randomized comparative cohort study with data collected retrospectively from an existing database compiled by a single surgeon operating in Sydney, Australia from 2007 to 2019. The primary outcome measure was intraocular pressure. Secondary outcome measures were a number of glaucoma medications, treatment success rates, best-corrected visual acuity, bleb morphology, post-operative complications, and re-operation rate. Results The mean intraocular pressure was 10.6 ± 2.7 mm Hg in the trabeculectomy group (pre-operative mean intraocular pressure of 28.0 ± 9.8) and 12.0 ± 3.0 mm Hg in the phacotrabeculectomy group (pre-operative mean intraocular pressure of 23.4 ± 7.9) after five years (P = 0.052). The number of glaucoma medications required was 0.3 ± 0.7 in the trabeculectomy group (pre-operative mean of 3.7 ± 1.1) and 1.3 ± 1.2 in the phacotrabeculectomy group (pre-operative mean of 3.1 ± 1.0, P < 0.001). Conclusions Intraocular pressure reduction post-operatively over five years was similar between trabeculectomy and phacotrabeculectomy as determined by mean intraocular pressure, and intraocular pressure reduction from baseline.
    [Show full text]