RESUMO
RESUMO O glaucoma é considerado a maior causa de cegueira irreversível no mundo, e o aumento da pressão intraocular constitui seu principal fator de risco. Usualmente, a terapia inicial do glaucoma consiste na redução da pressão intraocular a partir da instilação de drogas hipotensoras tópicas, estando as cirurgias antiglaucomatosas reservadas, na maioria das vezes, para casos em que o controle da doença não é atingido clinicamente. Classicamente, o tratamento cirúrgico do glaucoma é realizado a partir dos procedimentos filtrantes: trabeculectomia e implante de dispositivos de drenagem. O acrônimo MIGS (do inglês minimally invasive glaucoma surgery, procedimentos minimamente invasivos para glaucoma) corresponde a um grupo de procedimentos cirúrgicos pouco invasivos, que propõem a redução pressórica de maneira mais segura e previsível, quando comparada às técnicas cirúrgicas antiglaucomatosas convencionais.
ABSTRACT Glaucoma is considered the biggest cause of irreversible blindness in the world and the increase in intraocular pressure is its main risk factor. Usually, the initial therapy for glaucoma consists of reducing IOP through the instillation of topical hypotensive drugs, with antiglaucoma surgeries being normally reserved for cases in which disease control is not clinically achieved. Classically, the surgical treatment of glaucoma is performed using filtering procedures: trabeculectomy; non-penetrating sclerotomy and glaucoma drainage devices. The acronym MIGS (Minimally Invasive Glaucoma Surgery) corresponds to a group of minimally invasive surgical procedures that provide a safer and more predictable pressure reduction when compared to conventional antiglaucoma surgical techniques.
Assuntos
Humanos , Glaucoma/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Malha Trabecular/cirurgia , Trabeculectomia , Stents , Cirurgia Filtrante , Implantação de Prótese , Implantes para Drenagem de Glaucoma , Injeções Intraoculares , Géis , Gonioscopia , Pressão IntraocularRESUMO
AIM AND OBJECTIVE: To present a case of bilateral delayed-onset hyphema following the administration of a 1% tropicamide and 2.5% phenylephrine fixed combination ophthalmic agent, in the late follow-up period of a gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract extraction. BACKGROUND: Gonioscopy-assisted transluminal trabeculotomy consists on a 360° trabeculotomy through an ab interno approach that may also be combined with cataract surgery. Delayed-onset hyphema has been reported with trabecular minimally invasive glaucoma surgery (MIGS) procedures. Some proposed mechanisms are ocular compression and decompression during sleeping on the surgical side and episcleral venous pressure rise after physical activity. CASE DESCRIPTION: We describe the case of a 68-year-old female patient with ocular hypertension (OHT) and bilateral cataracts who underwent uncomplicated combined GATT and cataract extraction surgery. Postoperatively, 8 months after the left eye (OS) surgery and 3 months after the right eye (OD) surgery, patient came for routine evaluation. After induced mydriasis, slit-lamp evaluation revealed the presence of 3+ OD and 4+ OS erythrocytes in the anterior chamber (AC). Prednisolone acetate was prescribed q.i.d. and remission of hyphema was achieved after 2 weeks. Subsequently, 4 months later, the pupil dilation was again induced showing 4+ erythrocytes in both eyes (OU), layered hyphema in the inferior quadrant OS, and intraocular pressure (IOP) spike OU. The intraocular pressure was controlled after oral acetazolamide was prescribed. Topic prednisolone was initiated, and after 1 week, the hyphema was resolved in OU. CONCLUSION: Delayed-onset microhyphema may occur following induced mydriasis even months after the uncomplicated GATT procedure. Ophthalmologists should be aware of the possibility of microhyphema after induced mydriasis and the risks that this might represent with noteworthy and repeated IOP spikes which may eventually require treatment. CLINICAL SIGNIFICANCE: Delayed-onset hyphema and IOP spikes may occur following the pupil dilation with fixed combination of phenylephrine and tropicamide ophthalmic agent after the uncomplicated GATT procedure. HOW TO CITE THIS ARTICLE: Espinoza G, Rodriguez-Una I, Pedraza-Concha A. A Case of Bilateral Delayed-onset Hyphema Following Pupil Dilation after Gonioscopy-assisted Transluminal Trabeculotomy. J Curr Glaucoma Pract 2020;14(2):72-75.
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PURPOSE: To report a case and management of persistent hypotony with hypotony-induced maculopathy after CyPass® device implant. BACKGROUND: The CyPass® was the first supraciliary ab interno device approved by FDA and commercially available. Efficacy studies showed adequate intraocular pressure (IOP)-lowering results in combination with phacoemulsification. Hypotony induced by suprachoroidal minimally invasive glaucoma surgery (MIGS) was reported to be lower than 3% in the population that comprised the COMPASS study. CASE DESCRIPTION: A 57-year-old female patient with mild open-angle glaucoma with maximum topical medical therapy who underwent sequential bilateral CyPass® implantation developed persistent hypotony. Device obstruction was induced through argon laser burns directed to the peripheral iris, and the device was no longer visible on follow-up examinations. Topical IOP-lowering medication was restarted (timolol-dorzolamide) and has since been controlled under 16 mm Hg, without progression on visual fields. CONCLUSION: Argon laser burns directed to the peripheral iris to induce synechiae development that produces device obstruction are an effective technique to manage persistent hypotony after supraciliary CyPass® implantation. CLINICAL SIGNIFICANCE: Here, authors show a novel approach for treatment of persistent hypotony secondary to CyPass® implantation. In the knowledge of the authors, this is the first report that describes a noninvasive management for this complication, and this case could help other physicians to manage similar cases. HOW TO CITE THIS ARTICLE: Fernando DV-N, Díez-Cattini GF, Alfonso G-L, et al. Management of Persistent Hypotony after Supraciliary CyPass® Implantation Using Argon Laser. J Curr Glaucoma Pract 2019;13(3):116-118.
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La cirugía del glaucoma es una opción de tratamiento encaminada a disminuir la presión intraocular, una vez que no hay respuesta a las alternativas no quirúrgicas. En los últimos años está experimentando una evolución sorprendente. Aparecen nuevos dispositivos que buscan obtener un control tensional con las mínimas complicaciones. Actualmente se reserva el término minimally invasive glaucoma surgery para el grupo de técnicas quirúrgicas que favorecen el drenaje del humor acuoso vía ab-interno a través de la córnea clara y con las cuales con frecuencia se coloca un dispositivo biocompatible en el ángulo camerular. El Ex-PRESS, el Trabectome, el iStent y recientemente el Cypass (julio, 2016) son los únicos aprobados por la FDA. Pendiente de esto se encuentran el Hydruss y el XEN. Sin embargo, es necesario para la mayoría de ellos mostrar su éxito en el tiempo(AU)
Glaucoma surgery is a therapeutic alternative aimed at reducing the intraocular pressure when there is no response to non-surgical medical treatment. In the last few years, glaucoma surgery has remarkably evolved. New devices, capable of achieving pressure management with minor complications, have emerged. The term MIGS (minimally invasive glaucoma surgery) is reserved only for those techniques that favor aqueous humor drainage ab-interno approach through clear corneal incision and usually a biocompatible device is placed into the anterior chamber angle. The Ex-PRESS, Trabectome, iStent and recently Cypass (July 2016) are the only devices approved by the Food and Drug Enforcement Agency (FDA). Hydrus and Xen are still pending on approval. Nevertheless, it is required that most of them prove their success in the course of time(AU)
Assuntos
Humanos , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma/cirurgia , Trabeculectomia/métodosRESUMO
La extracción de la catarata produce una significante y sustancial reducción de la presión intraocular en individuos con glaucoma de ángulo abierto, hipertensión ocular y glaucoma por cierre angular. Remover la catarata mejora la interpretación de las pruebas perimétricas. Es recomendable restablecer las imágenes de base del nervio óptico, así como el campo visual después de la extracción de la catarata. La secuencia de cirugía de catarata y cirugía de glaucoma disminuye la probabilidad de complicaciones y aumenta el éxito quirúrgico. Tiene múltiples beneficios realizar la cirugía de catarata antes que la cirugía de glaucoma, mientras que la cirugía de catarata después de la trabeculectomía incrementa el riesgo de fallo de la filtración. Como la cirugía de glaucoma mínimamente invasiva continúa mejorando en términos de eficacia, esta juega un rol importante en la cirugía combinada de glaucoma y catarata en pacientes con glaucoma en estadios inicial y moderado. La combinación de cirugía de catarata con implante valvular o trabeculectomía por uno o dos sitios, también ofrece ventajas en pacientes con glaucoma avanzado. La presente revisión tiene como objetivo resumir el papel de la cirugía de catarata en el tratamiento del glaucoma teniendo en cuenta el efecto en la presión intraocular y las ventajas que ofrece en aquellos pacientes con ambas condiciones(AU)
Cataract extraction produces a significant, substantial reduction in intraocular pressure in people with open-angle glaucoma, ocular hypertension and angle closure glaucoma. Cataract removal improves the interpretation of perimetric tests. After cataract extraction it is advisable to re-establish the base optic nerve images and the visual field. The cataract surgery - glaucoma surgery sequence reduces the chances of complications and increases surgical success. It is very beneficial to perform cataract surgery before glaucoma surgery, whereas cataract surgery following trabeculectomy increases the risk of filtration failure. Minimally invasive glaucoma surgery continues to improve in terms of efficacy, thus playing an important role in combined glaucoma-cataract surgery in patients with early-stage, moderate glaucoma. Combined cataract surgery and valve implant or one- or two-site trabeculectomy is also advantageous in patients with advanced glaucoma. The present review is aimed at summarizing the role of cataract surgery in the treatment of glaucoma in terms of its effect on intraocular pressure and its advantages for patients with both conditions. Key words: phacoemulsification, cataract, glaucoma, trabeculectomy, combined surgery, MIGS(AU)