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Glaucoma

Surgery

This book is dedicated to all the great teachers who made me think including Robert and Adele Trope, Wallace Foulds, Jeffery L. Jay, John Dudgeon, and William S. Lee

Graham E. Trope

Preface

Why a new Glaucoma surgery text at this time? A review of currently available texts reveals a paucity of readily available information for the Glaucoma Specialist. Although there are some excellent surgical texts for general ophthalmologists, there are few indepth texts available to help the Glaucoma specialist deal with complications seen after adult glaucoma surgery.

This book is divided into two sections. A “How to” section and a section on management of complications. Topics covered in the latter section include management of the postoperative eye with high intraocular pressure with deep chamber, the flat anterior chamber with high intraocular pressure and the flat chamber with low intraocular pressure. To aid learning surgery we have also included a surgical DVD. This DVD covers a number of important topics including Peng Khaw’s method of doing a trabeculectomy, how to insert an Ahmed valve and how to manage bleb problems. I am indebted to Professor Peng Khaw, Dr. Garry Condon and especially Dr. Wai-Ching Lam for their important contributions to the DVD. I would like to thank all the surgeons who gave their valuable time to the preparation of this book.

This book contains an international approach to glaucoma surgery and the management of complications. I make no apology for extensively utilizing Canadian expertise. My Canadian colleagues are expert in dealing with complications and as a result they have made substantial contributions to this new surgical text.

I sincerely hope this text will help practicing glaucoma specialists decide on the most appropriate surgery for their patients and help surgeons deal rationally with complications seen postoperatively in the adult eye.

Graham E. Trope, M.B., B.Ch., Ph.D., F.R.C.S.(C.),

F.R.C.Ophth., F.R.C.S. (E.D.), D.O. (R.C.P.&S.)

v

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

v

Biography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xi

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xiii

Section I Surgical Techniques

1.Indications, Pre-operative Evaluation, and

Outcomes of Filtering Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Arthur J. Sit and Graham E. Trope

2.

Glaucoma: Surgical Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13

 

Maurice H. Luntz and Graham E. Trope

 

3.

Modern Anesthesia for Adult Glaucoma Filtration Surgery . . . . . . . . . . . . .

17

 

Monica M. Carrillo and Graham E. Trope

 

4.Advances in the Modulation of Wound Healing Including Large Treatment Areas and Adjustable

Sutures: The Moorfields Safe Surgery System . . . . . . . . . . . . . . . . . . . . . .

31

Peng Tee Khaw and Graham E. Trope

 

5. How to Do a Trabeculectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45

Clive Migdal and Graham E. Trope

 

6.Nonpenetrating Glaucoma Surgery: Indications,

 

Techniques, and Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51

 

Tarek Shaarawy, Graham E. Trope, and Andre´ Mermoud

 

7.

How to Insert a Glaucoma Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

63

 

Jeffrey Freedman and Graham E. Trope

 

8.

Management of Glaucoma Implant Complications . . . . . . . . . . . . . . . . . . .

75

 

Jeffrey Freedman, Shlomo Melamed, and Graham E. Trope

 

vii

viii

 

Contents

9.

Pars Plana Insertion of Ahmed Glaucoma Valve . . . . . . . . . . . . . . . . .

. . . . 83

 

Roland Ling, Wai-Ching Lam, and Graham E. Trope

 

10.

Full-Thickness Filtering Glaucoma Surgery . . . . . . . . . . . . . . . . . . . . .

. . . 93

 

Maurice H. Luntz and Graham E. Trope

 

11.

How to Do a Surgical Iridectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 101

 

Maurice H. Luntz and Graham E. Trope

 

12.

Combined Cataract and Glaucoma Surgery . . . . . . . . . . . . . . . . . . . . . .

. . . 107

 

Ruth Lapid-Gortzak, David S. Rootman, Yvonne M. Buys,

 

 

and Graham E. Trope

 

13.

Ultrasound Biomicroscopy in Glaucoma Surgery . . . . . . . . . . . . . . . . .

. . . 119

 

Charles J. Pavlin and Graham E. Trope

 

Section II Management of Complications

14.Overview: An Approach to the Diagnosis of Early

Postoperative Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

135

Yvonne M. Buys and Graham E. Trope

 

A.Management of High Intraocular Pressure with a Deep Chamber

15.

Massage: Techniques and Complications . . . . . . . . . . . . . . . . . . . . . . . . . .

139

 

Yvonne M. Buys and Graham E. Trope

 

16.

Glaucoma Suture Lysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

145

 

Graham E. Trope

 

17.

Releasable Sutures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

151

 

Ruth Lapid-Gortzak, David S. Rootman, and

 

 

Graham E. Trope

 

18.

The Failing Bleb: Risk Factors and Diagnosis . . . . . . . . . . . . . . . . . . . . . .

159

 

Paul R. Healey and Graham E. Trope

 

19.

Encapsulated Bleb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

179

 

Adael S. Soares, Marcelo T. Nicolela, Paul E. Rafuse,

 

 

and Graham E. Trope

 

20.

Needling Procedures in Postoperative Management

 

 

of Glaucoma Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

187

 

Tarek Shaarawy, Pieter Gouws, Graham E. Trope,

 

 

and Andre Mermoud

 

B.Management of Flat Anterior Chamber with High Intraocular Pressure

21.Suprachoroidal Hemorrhage in Filtering Surgery and

Practical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Ravikrishna Nrusimhadevara, R. G. Devenyi, and

Graham E. Trope

Contents

ix

22. Malignant Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Dimitrios Kourkoutas, Charles J. Pavlin, and Graham E. Trope

C.Management of a Flat Chamber with Low Intraocular Pressure

23.

Management of the Leaking Bleb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

217

 

Andrew C. Crichton, Garry P. Condon, and Graham E. Trope

 

24.

Remodeling the Filtration Bleb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

225

J.E. Morgan and Graham E. Trope

25.Management of Flat Anterior Chambers and

Choroidal Effusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Ridia Lim, Ivan Goldberg, and Graham E. Trope

26. Hypotony Maculopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247

Catherine M. Birt and Graham E. Trope

D.Management of Bleb Infection

27.Blebitis and Bleb-Associated Endophthalmitis:

Diagnosis and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Fani Segev, Allan R. Slomovic, and Graham E. Trope

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

265

Biography

Dr. Graham E. Trope is Professor of Ophthalmology at the University of Toronto. He has directed the Glaucoma Service at University Health Network since 1984. Dr. Trope is the past Chairman of Ophthalmology at the University of Toronto. He has published over 115 scientific articles, has been involved in Glaucoma Research and Treatment for over 20 years and is the Founder and Scientific Director of Glaucoma Research Society of Canada. He is incoming Editor-in-Chief of the Canadian Journal of Ophthalmology and he sits on a number of editorial boards including the Journal of Glaucoma. He has won a number of awards including The Ontario College of Physicians and Surgeons Council Award for his contributions to patient care. He has trained more than 20 glaucoma fellows from all over the world and is a past examiner for the Royal College of Physicians and Surgeons of Canada. He is a member of a number of learned societies and has published a book entitled Glaucoma, A Patient’s Guide to the Disease which is in its 3rd edition.

xi

Contributors

Catherine M. Birt, M.A., M.D., F.R.C.S.(C.) Associate Professor, Department of Ophthalmology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada

Yvonne M. Buys, M.D., F.R.C.S.(C.) Associate Professor of Ophthalmology, University Health Network and University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada

Monica M. Carrillo, M.D. Clinical and Research Fellow, Department of Ophthalmology, Dalhousie University, Halifax, Nova Scotia, Canada

Garry P. Condon, M.D. Clinical Associate Professor, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA

Andrew C. Crichton, M.D., F.R.C.S.(C.) Clinical Associate Professor, University of Calgary, Calgary, Alberta, Canada

R. G. Devenyi, M.D., F.R.C.S.(C.) Professor of Ophthalmology & Ophthalmologist in Chief and Director of Retinal Services, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada

Jeffrey Freedman, M.B., B.Ch., Ph.D., F.C.S.(S.A.), F.R.C.S.E. Professor of Clinical Ophthalmology, Department of Ophthalmology, S.U.N.Y. Brooklyn, Brooklyn, New York, USA

Ivan Goldberg, M.B.B.S., F.R.A.N.Z.C.O., F.R.A.C.S. Ophthalmologist, Eye Associates and Sydney Eye Hospital, Sydney, Australia

Pieter Gouws, M.B., B.Ch., F.R.C.Ophth. Glaucoma Fellow, Department of Ophthalmology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada

Paul R. Healey, M.B.B.S.(Hons.), B.Med.Sc. (Cell Biology), M.Med. (Clinical Epidemiology), F.R.A.N.Z.C.O. Ophthalmic Surgeon, Director of Glaucoma Services and Clinical Senior Lecturer, Western Sydney Eye Hospital; University of Sydney, Centre for Vision Research (Westmead Millennium Institute); and Save Sight Institute, Sydney, Australia

xiii

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