PubMed · 14641253
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Tarek Shaarawy. 2003. Glaucoma surgery: lest we forget.. https://doi.org/10.1111/j.1395-3907.2003.00203.x
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Approaches to treatment of the flat bleb after filtering surgery depends on the IOP, bleb appearance and absence or presence of a leak, anterior chamber depth, and the time since surgery. Treatment modalities include simple watching and waiting, reinstituting medical therapy, digital massage, laser suture lysis, YAG goniopuncture, or reoperation.
The definition of postoperative hypotony should be based on intraocular pressure (<5 mmHg) but should also take into account the associated anatomical risk, risk factors as well as the mechanisms involved, which vary depending on whether the anterior or posterior segment is concerned (presence or absence of the Seidel sign, primary or secondary ciliary body and choroidal detachment, etc.). The course to follow is based on evaluating the urgency of the situation so as to provide an adapted response. The choice and delay of the therapeutic response depends on the degree of inflammation of the bleb, the degree of athalamia (3 stages), and the aspect of the posterior pole. In case one or the other chosen technique fails (simple surveillance, bandage, protective eye shield, contact lens, laser, etc.), surgical revision of the operative site may be necessary. The anterior chamber must be reinflated using viscoelastic in certain situations. Much rarer is the need for intervention on the posterior pole after UBM, B ultrasound, and gonioscopy. Cases of severe and delayed secondary hypotonia with conjunctiva-scleral necrosis require rapid reoperation.
PURPOSE: To assess the annual number of glaucoma operations and admissions in the public sector tertiary care hospitals in Pakistan. METHODS: Eye departments in all 18 public tertiary care centers in the country were requested to provide data on the number of glaucoma operations and admissions during 1998. Of these, 13 hospitals agreed to participate. Eye departments' log books or patients' records were used to collect data retrospectively on the total number of eye admissions, the total number of glaucoma admissions, the type of glaucoma, and the total number and type of glaucoma operations. RESULTS: Glaucoma accounted for 8.1% (1,942/23,931) of all eye admissions. Open-angle glaucoma was responsible for 37.6% or 731 glaucoma admissions followed by secondary glaucoma (35.0%) and angle-closure glaucoma (18.2%). During 1998, 1,407 glaucoma-related operations were performed in the selected hospitals. The mean (+/-SD) and the median number of operations performed were 108.2 (+/-59.6) and 112 (range: 17-206), respectively. Trabeculectomies accounted for 1,043 (74.1 %) of all procedures. Their number ranged from 16 to 170 (median: 84) in the selected hospitals. CONCLUSIONS: We believe that the annual number of glaucoma operations performed in the public tertiary care hospitals in Pakistan is far less than required. In-depth research is therefore needed to explain if this is because of gaps in service provision or a genuine shift to medical management of glaucoma on an outpatient basis.