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Chapter 112 - Glaucoma surgery
- from Section 23 - Ophthalmic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 702-703
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- Chapter
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Summary
Glaucoma is the most common cause of optic neuropathy. Many ocular conditions may lead to the development of glaucomatous nerve damage. In general, therapeutic interventions are directed towards lowering intraocular pressure, a key risk factor for disease progression.
Typically, therapy begins with topical medications, the first and simplest option. These include the prostaglandin analogs, beta adrenergic receptor blockers, carbonic anhydrase inhibitors, alpha adrenergic agonists, and miotics. These agents are used alone or in combination, and are often sufficient to control intraocular pressure. In cases of open-angle glaucoma, laser trabeculoplasty may also be used to lower intraocular pressure. Laser interventions are performed in the clinic either alone or in combination with medical therapy. For cases of angle-closure glaucoma, laser iridotomy may be performed to either treat or prevent pupillary block (iris-lens diaphragm obstruction), an anatomic predisposition that is responsible for the majority of cases. Cyclodestructive surgery (intentional destruction of the ciliary body tissues) is another laser procedure that may be used when other interventions have failed, including incisional surgery. These procedures, which are usually performed in the clinic under local anesthesia, are commonly performed with lasers and, less commonly, cryotherapy.
104 - Glaucoma surgery
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- By Anastasios P. Costarides, Emory University, School of Medicine, Atlanta, GA, G. Baker Hubbard III, Emory University, School of Medicine, Atlanta, GA, Enrique Garcia-Valenzuela, Emory University, School of Medicine, Atlanta, GA, Thomas M. Aaberg, Sr., Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 704-705
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- Chapter
- Export citation
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Summary
Multiple ocular conditions can lead to the development of glaucoma, which is the most common optic neuropathy. All therapeutic interventions are directed towards lowering the condition's greatest risk factor, intraocular pressure.
Typically, therapy is instituted in an ascending fashion, with topical medical therapy being the first and simplest option. Medications include topical beta adrenergic blockers, prostaglandin analogs, carbonic anhydrase inhibitors, alpha adrenergic agonists, and miotics; these agents, used alone or in combination, are often sufficient for control of intraocular pressure. In cases of open angle glaucoma requiring greater management of intraocular pressure, laser trabeculoplasty, an outpatient procedure, is used in conjunction with medications. For angle closure glaucoma, outpatient laser iridotomy is applied to relieve the pupillary block mechanism.
Incisional intraocular surgery is the most frequent choice when medical and outpatient laser procedures fail to diminish intraocular pressure, with trabeculectomy and aqueous tube shunt placement being the most commonly used procedures. Both approaches lower intraocular pressure by allowing aqueous humor to leave the anterior chamber and collect in the subconjunctival space. When other interventions have either failed or are unfeasible, such cyclodestructive procedures as laser ablation or cryoablation of the ciliary processes may be done. Incisional surgery is done in an operating room, usually on an outpatient basis; cyclodestructive operations are performed in a clinic setting; and local anesthesia is standard for both methods.
Usual postoperative course
Expected postoperative hospital stay
Glaucoma surgery usually does not require hospitalization, though monocular patients undergoing incisional surgery may be hospitalized.