Ординатура / Офтальмология / Английские материалы / Glaucoma Surgery_Trope_2005
.pdfIndex
failing bleb, 172, 173
injected through viscoelastic wall, 41 needling, 189
postoperative injection, 40 43 wound healing, 32
Fluorouracil Filtering Surgery Study (FFSS), 10, 162 163, 172
Focal cystic bleb mitomycin C (MMC), 37
Formed anterior chamber high IOL, 135 137 low IOL, 137
Fornix dissection, 37
Full thickness filtering glaucoma surgery, 93 99
closure, 97 99 sclerectomy, 99
subscleral Scheie procedure, 94 subscleral trephine, 99 technique, 94 97, 98 99
Gatifloxacin blebitis, 259
General anesthesia filtering surgery, 19 20
General health status filtering surgery, 9
Glaucoma see also primary open angle glaucoma (POAG)
ciliary block, 200 congenital, 53 exfoliative, 53 malignant, 199 213 neovascular, 53
failing bleb, 164 pigmentary, 53
surgical anatomy, 13 15 Glaucoma drainage implant (GDI)
surgery, 83, 84 pars plana
results and complications, 90 91 Glaucoma implant, 63 73
anesthesia, 64 complications
intraoperative complications, 76 77 management, 75 81
conjunctival incision, 64 drainage failure, 79
express glaucoma shunt, 72 73 flat anterior chamber, 77 79
late postoperative complications, 79 81 patch graft, 66 72
plate attachment, 64 65
269
technique, 64 77
tube preparation, 66 72 valve priming, 66
Glaucoma medication compliance, 6
failing bleb, 163 164 Glaucoma shunt
glaucoma implant, 72 73
Glaucoma surgery see also nonpenetrating glaucoma surgery (NPGS)
anatomy, 13 15
angle closure, 101 105 combined with cataract surgery,
107 116
full thickness filtering, 93 99 low IOP and shallow AC
differential diagnosis, 226 postoperative management
needling, 187 191 ultrasound biomicroscopy,
119 129
Glaucoma suture lysis, 145 148 complications, 147 148 external aqueous leaks, 147 indications, 145
laser settings, 147 outcome, 147 timing, 145 146
Goniopuncture
Nd:YAG
after nonpenetrating glaucoma surgery, 57 58
Grepafloxacin blebitis, 259
Grieshaber hooks, 111
Haemophilus influenzae blebitis, 258
Harms forceps
glaucoma implant, 64, 65 High IOL
anterior chamber, 135 137 High myopia
nonpenetrating glaucoma surgery, 52 53
Hoskin forceps, 103 Hydrodissection
combined cataract and glaucoma surgery, 115
Hyoscine (scopolamine), 208 Hypertensive phase
glaucoma implant, 78 Hyphema
glaucoma suture lysis, 148
270
Hypotony
glaucoma suture lysis, 147 nonpenetrating glaucoma
surgery, 59
Hypotony maculopathy, 247 251 causes, 248
defined, 247 diagnosis, 248 249 incidence, 249 prognosis, 251
risk factors, 249 treatment, 249 251
Ideal filtration bleb, 226
Implant insertion see specific type Indiana Bleb Appearance Grading
Scale, 166, 167 Inflammation
nonpenetrating glaucoma surgery, 59
Informed consent
combined cataract and glaucoma surgery, 107 108
Infusion port
pars plana vitrectomy, 86 Intraocular inflammation
assessment, 237
Intraocular pressure (IOP), 4, 94 assessment, 237
low
glaucoma surgery differential diagnosis, 226
nonpenetrating glaucoma surgery, 59 postoperative increase, 59
Intraoperative antimetabolites application technique, 35 42
Intrascleral obstruction failing bleb, 165 166
Intravenous medications, 20 adverse effects, 21
Iridectomy
full thickness filtering glaucoma surgery, 95 96
peripheral, 105, 112
angle closure glaucoma, 102 104 trabeculectomy, 48
Iridocorneal endothelial (ICE) syndrome, 84
Iris incarcerations
glaucoma suture lysis, 148 with ocular massage, 142
Iritis
glaucoma implant, 78 79
Index
Johnstone’s technique, 155, 156
Kolker’s modification, 155
Krupin implant, 64
Kuglin hooks, 111
Laser treatment Nd:YAG
malignant glaucoma, 208 209 Leaking bleb
defined, 218 early, 218
incisional repair, 220 221 late, 218 219
nonincisional correction, 219 observation, 219
treatment, 217 223 Lens zonules
malignant glaucoma, 202 Lidocaine (xylocaine), 21, 22, 26 27 Lifestyle
filtering surgery, 6 7 Local anesthesia
filtering surgery, 20 27 MAC, 20 21 maximum doses, 24
Malignant glaucoma, 199 213
aqueous humor misdirection, 201 202 Chandler’s technique, 211
clinical diagnosis, 200 201 differential diagnosis, 204 205 fellow eye, 212 213 glaucoma suture lysis, 148 laser treatment, 208 209
lens zonules, 202 management, 205 213
pars plana vitrectomy, 209 210
pars plana vitrectomy success rate, 209 pathophysiology, 201 202
positive pressure phenomenon, 202 204 pupillary block, 205
risk factors, 206 sequence of events, 203
suprachoroidal hemorrhage, 204 205 surgery, 209 210
terminology, 200 treatment, 206 208, 207
ultrasound biomicroscopy, 127 129 Marfan’s syndrome, 20
Massage, 139 143 complications, 142 143 indications, 139 140 mechanism, 140 141
Index
outcome, 143
patient technique, 142 surgeon technique, 141 technique, 140 141
Mechanical ptosis elevated bleb, 228
Mepivacaine, 22 Microcysts
failing bleb, 170 Migdal method
releasable sutures, 153 Mitomycin C (MMC)
applied directly to bleb site, 36 diffuse noncystic bleb, 41 failing bleb, 162
focal cystic bleb, 37 wound healing, 32
Molteno implant, 64, 66, 84 double plate insertion, 72
Monitored anesthesia care (MAC) local anesthesia, 20 21
Moorfields Safe Surgery System, 31 42
antifibrotic agents, 32 application technique, 35 42
Moxifloxacin blebitis, 259
Nasal conjunctiva elevated bleb, 228
Needles
glaucoma implant, 65, 69 Needling
adjunctive antimetabolite, 189 bleb survival, 191 complications, 190 encapsulated bleb, 183, 184 5 FU, 189
glaucoma surgery postoperative management, 187 191 interval between surgery, 189
potential risk factors, 190 repeated, 189
take home message, 190 191 technique, 188 189
Neodymium:YAG goniopuncture
after nonpenetrating glaucoma surgery, 57 58
laser treatment
malignant glaucoma, 208 209 Neovascular glaucoma
failing bleb, 164
nonpenetrating glaucoma surgery, 53
271
Nonpenetrating glaucoma surgery (NPGS), 51 60
complications, 58 60 contraindications, 53 indications, 52 53
Nd:YAG goniopuncture after, 57 58 open angle glaucoma, 52 pigmentary glaucoma, 53
results, 60 technique, 54 57
Nuclear cracking phacoemulsification, 111
Nuclear phacoemulsification combined cataract and glaucoma
surgery, 115
Ocular explosion, 23
Ocular Hypertension Treatment
Study (OSTS), 4 Ofloxacine, 188
Open angle glaucoma
nonpenetrating glaucoma surgery, 52 Osher method
releasable sutures, 154 Ostium
hemorrhage
with ocular massage, 142 Over filtration, 125 127
Paracentesis
full thickness filtering glaucoma surgery, 95 glaucoma implant, 69
trabeculectomy, 48 Pars Plana GDI
complications, 90, 91 Pars Plana insertion, 83 91
indications, 84 technique, 84 90
Pars Plana tube closure, 88 90 placement, 87 88
Pars Plana Vitrectomy (PPV), 86 87 malignant glaucoma, 209 210 success rate
malignant glaucoma, 209 Patch
trabeculectomy, 49 Patient information
combined cataract and glaucoma surgery, 107 108
Penetrating ocular injuries wound healing, 160 161
Pericardium
glaucoma implant, 67, 71
272
Peripheral anterior synechia nonpenetrating glaucoma surgery, 60
Peripheral iridectomy, 105, 112 angle closure glaucoma, 102 104 trabeculectomy, 48
Peritomy
crescent blade, 110 Phacoemulsification
nuclear cracking, 111 Phacotrabeculectomy, 108
two site technique
combined cataract and glaucoma surgery, 113 114
Phenylephrine, 188 Pigmentary glaucoma
nonpenetrating glaucoma surgery, 53 Plate erosion
glaucoma implant, 79 80 Positive pressure phenomenon
malignant glaucoma, 202 204 Posterior lip sclerectomy
full thickness filtering glaucoma surgery, 99
Posterior sclerotomy, 243 Postoperative drops
trabeculectomy, 49 Prednisolone
failing bleb, 172 Procaine, 21, 22 Propofol, 20
Proprionibacterium acnes blebitis, 258
Pseudoexfoliation
combined cataract and glaucoma surgery, 115
Pupil block, 137 Pupillary block
malignant glaucoma, 205
Quality of life
filtering surgery, 6 7
Race
failing bleb, 164 Radiation
applied directly to bleb site, 36 Reflective filtering bleb, 122 Releasable sutures, 151 157
with buried ends, 153 154 Cohen method, 154 complications, 156 157 indications, 151
Index
Migdal method, 153 Osher method, 154 techniques, 152 153
Releasable U suture, 152 153 Remifentanyl, 20
Retinal detachment
combined cataract and glaucoma surgery, 116
Retinal vascular occlusion, 23 Retrobulbar anesthesia, 22 24
complications, 23 24 technique, 22 23
Retrobulbar hemorrhage, 23 Rootman technique, 152 Ropivacaine, 21, 22
Scarring
risk factors, 34 Scheie procedure
subscleral, 94 Schlemm’s canal, 55 Schocket GDI, 84 Scleral ectasia
nonpenetrating glaucoma surgery, 60 Scleral flap
antimetabolite intraoperative application, 37 38
closure
trabeculectomy, 48 49 formation, 110
full thickness filtering glaucoma surgery, 95, 98
repair, 244 sutures
antimetabolites intraoperative application, 39
Scleral perforation, 23 Sclerectomy
with collagen implant, 124 nonpenetrating glaucoma surgery, 54 57
Scopolamine, 208 Shallow/flat anterior chamber
with choroidal effusions assessment, 236 238 treatment, 239 without leak, 239 243
glaucoma implant, 77 79 high IOL, 137 intraoperative prevention,
238 240
low IOL, 137 138 management, 235 244 reforming, 240 243
Index |
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273 |
reinflating, 242 |
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scleral flap |
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surgery, 240 |
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antimetabolites intraoperative |
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Silicone tube |
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application, 39 |
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glaucoma implant, 70 |
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tube |
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Skin color |
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glaucoma implant, 68 |
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failing bleb, 164 |
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Suturing |
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Slit lamp needle procedure |
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conjunctival flap |
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malignant glaucoma after |
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trabeculectomy, 49 |
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trabeculectomy |
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Symblepharon |
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in pseudophakic eye, 211 |
212 |
filtering surgery, 9 |
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Staphylococcus aureus |
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Synechiae, 124 |
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blebitis, 258 |
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Systemic antifibrosis therapy |
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Staphylococcus epidermidis |
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failing bleb, 172 |
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blebitis, 258 |
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Steroids |
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Tenon’s conjunctiva |
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trabeculectomy, 49 |
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and sclera, 64 |
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Streptococcus |
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Tenon’s cysts |
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blebitis, 258 |
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encapsulated bleb, 183 |
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Subconjunctival/sub Tenon’s |
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failing bleb, 169 |
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anesthesia, 24 |
26 |
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Tenon’s Fascia |
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complications, 25 |
26 |
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surgical limbus, 13 |
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technique, 25 |
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Tetracaine, 22 |
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Subscleral Scheie procedure, 94 |
Tissue repair |
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Subscleral trephine |
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sequence of events, 33 |
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full thickness filtering glaucoma |
Topical anesthesia, 26 27 |
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surgery, 97 98 |
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with eyedrops, 27 |
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Sufentanyl, 20 |
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Trabeculectomy, 45 50, 112, 160 |
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Superonasal port |
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anesthesia, 47 |
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pars plana vitrectomy, 87 |
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anterior chamber reformation, 49 |
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Superotemporal port |
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conjunctival flap, 46 |
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pars plana vitrectomy, 87 |
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conjunctival flap suturing, 49 |
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Suprachoroidal hemorrhage, 137 |
early postoperative |
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filtering surgery, 193 |
196 |
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complications, 136 |
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malignant glaucoma, 204 205 |
globe positioning, 46 |
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Supraciliary effusions, 127 |
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limbal incision, 47 |
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Suramin |
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paracentesis, 48 |
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wound healing, 32 |
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peripheral iridectomy, 48 |
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Surgery. see also specific type |
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postoperative care, 49 |
50 |
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combined |
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postoperative drops, 49 |
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failing bleb, 164 |
165 |
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scleral flap closure, 48 |
49 |
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Surgical iridectomy, 101 105 |
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technique, 45 49 |
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Surgical limbus |
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Trabeculo Descemet’s membrane |
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conjunctiva, 13 |
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(TDM), 52 57 |
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filtering surgery, 13 |
15 |
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perforation, 58, 59 60 |
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Tenon’s Fascia, 13 |
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Trabio |
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Sutures |
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wound healing, 32, 34 |
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compression |
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Trovafloxacin |
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elevated bleb, 231 |
233 |
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blebitis, 259 |
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conjunctival |
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Tube complications |
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buried knots, 113 |
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glaucoma implant, 76 |
77 |
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glaucoma implant, 66 |
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Tube corneal touch |
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glaucoma suture lysis, 145 |
148 |
glaucoma implant, 78 |
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releasable, 151 157 |
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Tube erosion |
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releasable U suture, 152 153 |
glaucoma implant, 79 |
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274
Tube stent
glaucoma implant, 66 Tube suture
glaucoma implant, 68 Tube trimming
glaucoma implant, 68 69
Two site phacotrabeculectomy technique combined cataract and glaucoma surgery,
113 114
Ultrasound biomicroscopy, 120 Ahmed valve, 126
assessing filtration, 121 125 clinical use, 120 121 cyclodialysis cleft, 127 filtering bleb, 125
filtering surgery, 121 124 glaucoma surgery, 119 129 malignant glaucoma, 129 measuring ocular structure, 121 technique, 120 121
U suture
releasable, 152 153 Uttrata forceps, 111 Uveitis
failing bleb, 164
Index
Valve priming glaucoma implant, 66
Valves
filtering surgery, 125 Viscocanalostomy, 124
nonpenetrating glaucoma surgery, 57 Vitreous loss
glaucoma implant, 77
Wound dehiscence glaucoma suture lysis, 147
Wound healing see Moorfields Safe Surgery System
penetrating ocular injuries, 160 161
surgical technique, 161 Wound leaks, 138
flat anterior chamber, 238 239 nonpenetrating glaucoma
surgery, 58 59
Xylocaine, 21, 22, 26 27 Xylocaine jelly
trabeculectomy, 47
Figure 2.2 Photograph of dissected 1/3 thickness scleral flap with anatomical land marks.
Figure 4.1 Changes in technique leading to improvements in outcome following the use of antimetabolites.
Figure 4.2 Patient’s left eye treated with smaller area of mitomycin c
0.4mg/mL showing focal cystic bleb. Left eye treated with mitomycin c
0.5mg/mL and large area showing diffuse noncystic bleb.
Figure 4.3 Fornix dissection to ensure large surface area of treatment.
Figure 4.4 Special clamp pro tecting conjunctiva while folded sponges are being inserted.
Figure 4.5 New adjustable sutures being adjusted through the conjunctiva using special finely machined forceps. For video, see http://www.ucl.ac. uk/ioo/research/khaw.htm
Figure 4.6 Injection of 5FU being given through a visco elastic wall.
Figure 4.7 Example of diffuse noncystic bleb with intraocular pressure of 12 mmHg 5 years after surgery using mitomycin 0.5 mg/mL and described tech niques. This result may be poss ible for the majority of patients having filtration surgery with improvements of current tech niques, and can lead to a dramatic reduction in complications.
Figure 6.1 Sclerectomy, ab externo trabeculectomy, deep sclerectomy.
Figure 6.2 Dissection of superficial scleral flap.
Figure 6.3 Dissection of deep flap, excision, and exposure of Schlemm’s canal.
Figure 6.4 Peeling of the innerwall of Schlemm’s canal and juxtacanalicular trabeculum.
Figure 6.5 Implantation of a collagen implant.