Ординатура / Офтальмология / Английские материалы / Step by Step Minimally Invasive Glaucoma Surgery_Garg, Melamed, Bovet, Pajic, Carassa, Dada_2006

192 Step by Step Minimally Invasive Glaucoma Surgery

48.Han SK, Park KH, Kim DM, et al. Effect of diode laser transscleral cyclophotocoagulation in the management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments. Br J Ophthalmol 1999 Jun;83(6):713-7.

49.Kosoko O, Gaasterland DE, Pollack IP, Enger CL. Longterm outcome of initial ciliary ablation with contact diode laser trans-scleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophthalmology 1996 Aug;103(8):1294-302.

50.Bloom PA, Tsai JC, Sharma K, Miller MH, Rice NS, Hitchings RA, Khaw PT. “Cyclodiode”. Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma. Ophthalmology 1997 Sep;104(9): 1508-19.

51.Spencer AF, Vernon SA. “Cyclodiode”: results of a standard protocol. Br J Ophthalmol 1999 Mar;83(3):311-6.

52.Werner A, Vick HP, Guthoff R. [Cyclophotocoagulation with the diode laser. Study of long-term results] Ophthalmologe 1998 Mar;95(3):176-80.

53.Pucci V, Tappainer F, Borin S, et al. Long-term follow-up after transscleral diode laser photocoagulation in refractory glaucoma. Ophthalmologica 2003 Jul-Aug;217(4):279-83.

54.Noureddin BN, Zein W, Haddad C, Ma’luf R, Bashshur Z. Diode laser transcleral cyclophotocoagulation for refractory glaucoma: a 1-year follow-up of patients treated using an aggressive protocol. Eye 2005 Apr 29.

55.Ocakoglu O, Arslan OS, Kayiran A. Diode laser transscleral cyclophotocoagulation for the treatment of refractory glaucoma after penetrating keratoplasty. Curr Eye Res 2005 Jul;30(7):569-74.

56.Gupta V, Agarwal HC. Contact trans-scleral diode laser cyclophotocoagulation treatment for refractory glaucomas in the Indian population. Indian J Ophthalmol 2000 Dec;48(4):295-300.

57.Levinger E, Segev E, Geyer O. Diode laser cyclophotocoagulation in refractory glaucoma. Harefuah 2003 Jul;142(7):500-2, 568, 567.

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58.Mistlberger A, Liebmann JM, Tschiderer H, et al. Diode laser transscleral cyclophotocoagulation for refractory glaucoma. J Glaucoma 2001 Aug;10(4):288-93.

59.Gupta V, Agarwal HC. Contact trans-scleral diode laser cyclophotocoagulation treatment for refractory glaucomas in the Indian population. Indian J Ophthalmol 2000 Dec;48(4):295-300.

60.Kivela T, Puska P, Raitta C, et al. Clinically successful contact transscleral krypton laser cyclophotocoagulation. Long-term histopathologic and immunohistochemical autopsy findings. Arch Ophthalmol 1995 Nov;113(11): 1447-53.

61.Raivio VE, Immonen IJ, Puska PM. Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma in children and young adults. Ophthalmology 2001 Oct;108(10):1801-7.

62.Raivio VE, Immonen IJ, Laatikainen LT, et al. Transscleral contact krypton laser cyclophotocoagulation for treatment of posttraumatic glaucoma. J Glaucoma 2001 Apr;10(2):7784.

63.Di Staso S, Genitti G, Verolino M, et al. Trans-scleral krypton laser cyclophotocoagulation: our experience of its use on patients with neovascular glaucoma. Acta Ophthalmol Scand Suppl. 1997;(224):37-8.

64.Patel A, Thompson JT, Michels RG, et al. Endolaser treatment of the ciliary body for uncontrolled glaucoma, Ophthalmology 1986;93:825-30.

65.Lin S. Endoscopic cyclophotocoagulation. Br J Ophthalmol. 2002 Dec;86(12):1434-8. Review.

66.Holz HA, Lim MC. Glaucoma lasers: a review of the newer techniques. Curr Opin Ophthalmol 2005 Apr;16(2):89-93. Review.

67.Zarbin MA, Michels RG, de Bustros S, et al. Endolaser treatment of the ciliary body for severe glaucoma. Ophthalmology 1988 Dec;95(12):1639-48.

68.Chen J, Cohn RA, Lin SC, et al. Endoscopic photocoagulation of the ciliary body for treatment of refractory glaucomas. Am J Ophthalmol 1997 Dec;124(6):787-96.

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69.Uram M. Ophthalmic laser microendoscope ciliary process ablation in the management of neovascular glaucoma. Ophthalmology 1992;99:1823–8.

70.Uram M. Combined phacoemulsification, endoscopic ciliary process photocoagulation, and intraocular lens implantation in glaucoma management. Ophthalmic Surg 1995;26:346–52.

71.Neely DE, Plager DA. Endocyclophotocoagulation for management of difficult pediatric glaucomas. J AAPOS. 2001 Aug;5(4):221-9.

72.Cohen EJ, Schwartz LW, Luskind RD, et al. Neodymium: YAG laser transscleral cyclophotocoagulation for glaucoma after penetrating keratoplasty. Ophthalmic Surg 1989;20: 713–16.

73.Threlkeld AB, Shields MB. Noncontact transscleral Nd:YAG cyclophotocoagulation for glaucoma after penetrating keratoplasty. Am J Ophthalmol 1995;120:569– 76.

74.Lima FE, Magacho L, Carvalho DM, et al. A prospective, comparative study between endoscopic cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma. J Glaucoma 2004 Jun;13(3):233-7.

75.Bechrakis NE, Müller-Stolzenurg NW, Helbig, et al. Sympathetic ophthalmia following laser cyclophotocoagulation. Arch Ophthalmol 1994;112:80–4.

76.Mora JS, Iwach AG, Gaffney MM, et al. Endoscopic diode laser cyclophotocoagulation with a limbal approach. Ophthalmic Surg Lasers 1997 Feb;28(2):118-23.

77.Lim JI, Lynn M, Capone A Jr, et al. Ciliary body endophotocoagulation during pars plana vitrectomy in eyes with vitreoretinal disorders and concomitant uncontrolled glaucoma. Ophthalmology 1996 Jul; 103(7): 1041-6.

78.Lee P-F. Argon laser photocoagulation of the ciliary processes in cases of aphakic glaucoma, Arch Ophthalmol 1979;97:21352138.

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79.Herschler J. Laser shrinkage of the ciliary process. A treatment for malignant (ciliary block) glaucoma. Ophthalmology 1980;87:1155-9.

80.Merritt JC. Transpupillary photocoagulation of the ciliary processes. Ann Ophthalmol 1976 Mar;8(3):325-8.

81.Shields S, Stewart WC, Shields MB. Transpupillary argon laser cyclophotocoagulation in the treatment of glaucoma. Ophthalmic Surg 1988 Mar;19(3):171-5.

82.Lee PF, Shihab Z, Eberle M. Partial ciliary process laser photocoagulation in the management of glaucoma. Lasers Surg Med 1980;1(1):85-92.

83.Kim DD, Moster MR. Transpupillary argon laser cyclophotocoagulation in the treatment of traumatic glaucoma. J Glaucoma 1999 Oct;8(5):340-1.

84.Schuman JS, Puliafito CA. Laser cyclophotocoagulation. Int Ophthalmol Clin 1990;30:111-9.

85.Jennings BJ, Mathews DE. Complications of neodymium: YAG cyclophotocoagulation in the treatment of open-angle glaucoma. Optom Vis Sci. 1999 Oct;76(10):686-91.

86.Edward DP, Brown SVL, Higginbothom E, et al. Sympathetic ophthalmia following neodymium:YAG cyclotherapy. Ophthalmic Surg 1989;20:544–6.

87.Lam S. Tessler HH, Lam BL, et al. High incidence of sympathetic ophthalmia after contact and noncontact neodymium:YAG cyclotherapy. Ophthalmology 1992;99: 1818–22.

88.Bechrakis NE, Müller-Stolzenurg NW, Helbig, et al. Sympathetic ophthalmia following laser cyclophotocoagulation. Arch Ophthalmol 1994;112:80–4.

89.Azuara Blanco A, Dua HS. Malignant glaucoma after diode laser cyclophotocoagulation. Am J Ophthalmol 1999;127: 467-69.

90.Harden DR, Brown JD. Malignant glaucoma after Nd:YAG cyclophotocoagulation. Am J Ophthalmol 1991;111:245-47.

91.Wand M, Schuman JS, Pulinfito CA, et al. Malignant glaucoma after contact trans-scleral Nd:YAG laser cyclophotocoagulation. J Glaucoma 1993;2:110-111.

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92.Venkatesh P, Gogoi M, Sihota R, et al. Panophthalmitis following contact diode laser cyclophotocoagulation in a patient with failed trabeculectomy and trabeculotomy for congenital glaucoma. Br J Ophthalmol 2003;87(4):508.

93.Jonathan S Myers, M G trevisani, N Imami, et al. Laser reaching posterior pole during Transscleral cyclophotocoagulation. Arch Ophthalmol 1998;116:488-91.

94.Torsten schlote, M Derse, H J Thiel et al. Pupillary distortion after transscleral Diode laser cyclophotocoagulation. Br J Ophthalmol 2000;84:337-38.

95.Weigt AK, Herring IP, Marfurt CF, et al. Effects of cyclophotocoagulation with a neodymium:yttrium- aluminum-garnet laser on corneal sensitivity, intraocular pressure, aqueous tear production, and corneal nerve morphology in eyes of dogs. Am J Vet Res. 2002 Jun;63(6): 906-15.

96.Raivio VE, Vesaluoma MH, Tervo TM, et al. Corneal innervation, corneal mechanical sensitivity, and tear fluid secretion after transscleral contact 670-nm diode laser cyclophotocoagulation. J Glaucoma 2002 Oct;11(5):446-53.

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INTRODUCTION

Trabeculectomy has been the operation of choice for glaucoma since its introduction in 1961 and as a fullthickness operation it had its complications. Guarded filtration procedures were developed to reduce these risks such as hypotony, and infections.1-3 In the standard trabeculectomy, as reported by Cairns, the trabecular block is excised anterior to the scleral spur or alternatively from the posterior side as proposed by Watson.2 The success rate of trabeculectomy is influenced by several factors including patient’s characteristics, type of glaucoma and wound healing processes. Other important factors that might reduce the success of this surgery include tissue scarring, anterior segment neovascularization, active uveitis, aphakia, previous ocular surgery and chronic conjunctival inflammation.1-5

Over the past 10 years new modalities in glaucoma surgery have been introduced as possible alternatives to trabeculectomy. Krasnov and Zimmerman have identified those procedures into deep scleretomy and viscocanalostomy.3 The non-penetrating glaucoma surgeries aim to allow drainage of the aqueous humor by slow percolation through the inner trabecular meshwork and/or Descemet membrane (trabeculo-descemetic membrane) rather than through a patent scleral opening, as in standard trabeculectomy. This avoids sudden reductions in IOP, hypotony and flat chambers. Performing such a non-penetrating glaucoma surgeries has great advantages are the absence of anterior chamber opening and iridectomy, the facts that limit the risk of cataract and infection.6-9 In the past 10 years new non-penetrating modalities in glaucoma surgery were introduced as

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possible alternatives to Trabeculectomy. Krasnov and Zimmerman have proposed these procedures as deep sclerotomy and viscocanalostomy.3 The non-penetrating glaucoma surgeries aim to allow drainage of the aqueous humor by slow percolation through the inner trabecular meshwork and/or trabeculo-descemetic membrane rather than a patent trabeculoscleral opening, as in standard trabeculectomy. This avoids sudden reductions in IOP, hypotony and flat chambers. Non-penetrating glaucoma procedures have important potential advantages mainly the absence of anterior chamber opening and iridectomy, the fact that limits the risk of cataract and infection.6-9

One of the important targets while performing trabeculectomy or non-penetrating glaucoma surgeries is to minimize the stimulation of fibroblast proliferation that might reduce the success rate of the procedure. The cutting, spreading, and tearing of tissue should be kept to a minimum. In addition, the surgeon should strive to keep the incisions linear, rather than multilaminate, to maintain as small and localized incisional scars as possible.9-11

Milling trabeculoplasty is considered a variation of deep sclerectomy with more refining. The technique of milling trabeculoplasty provides the opportunity to perform a nonpenetrating glaucoma surgery with greater attention for the dissection of the deep scleral flap or the deroofing of the Schlemm´s canal with the addition advantage that is being much faster.12

INDICATIONS

Eyes with primary open angle glaucoma are the best candidates for the milling surgery. However, all indications of deep sclerectomy are cases of milling procedure.

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PATIENT PREPARATION

Preoperative Examination

Before surgery, each patient had manifest refraction, slitlamp biomicroscopy with measurement of IOP by using Goldman tonometry, gonioscopy and computerized perimetry.

Preoperative Medications

Medications included Ciprofloxacin 0.3 percent eye drops 3 times/day for a week. The topical antiglaucoma therapy was stopped 3 days before the surgery.

Anesthesia

Peribulbar anesthesia in the form of combination of 8 ml of 0.75 percent Bupivacaine and 2 percent Lidocaine was injected. Intravenous sedation was used when necessary. A light compression with the Honnan balloon was applied 15 minutes prior to surgery for 5 minutes to insure diffusion of the anesthetic agent.

MILLING SURGICAL PROCEDURE

Instruments

Milling drill (Katena Inc, Denville, NJ USA) is the main instrument necessary to perform this procedure. The mode of action of the drill is similar to that used to burr the nasal bone in dacryocystorhinostomy (DCR) surgery or that used to polish the bed after removing corneal foreign bodies. The drill used in our milling procedure is handheld 150 mg weight equipment and made of autoclaveble material (Fig. 12.1). Following the concept of refined tissue

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Fig. 12.1: Milling drill with the tips used in the surgery of milling

removal would decrease the rate of postoperative fibrosis, a high frequency and velocity motorized drill tip could be able to polish (no cutting method) the remaining scleral thickness with minimal tearing and smaller more localized scars at the end of the procedure.

The high speed Milling drill (6000 RPM) allows easy (Fig. 12.2), quick and more controlled refining of the remaining scleral thickness by using sharp-metallic tip first to refine the sclera and later on as the tissue became thinner another notched hemispherical metallic tip was used to polish and not cut the remaining scleral thickness (Fig. 12.3). A new tip covered with diamond powder is also needed for more delicate maneuvers as removing debris making the technique ideal to have an extremely smooth bed (Fig. 12.4). In both groups, the procedure started as the initial steps of deep sclerotomy13 then the specific steps of milling surgery were continued. In Group II, the milling procedure is carried out until Schlemm’s canal is identified. Thereafter, phaco is performed (through a separate clear corneal incision) and after the IOL was implanted, the milling procedure was finished.