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💻 On-demand replay WGA Surgical Grand Rounds

A big thank you to all our viewers who tuned in on Thursday, January 27, 2022, to watch the first-ever webinar in our “Surgical Grand Rounds” series. We want to extend our appreciation to all presenters and panelists who made this brand new initiative possible! Stay tuned for the second edition on April 14, 2022.

Program February 27, 2022

Treatment of bleb dysesthesia/overhanging blebs presented by Paul Palmberg. Panelists: Yvonne Buys and Peng Khaw. Moderated by Tanuj Dada.
Pseudoexfoliation glaucoma with small pupil and cataract with zonular weakness presented by Arsham Sheybani. Panelists: Antonio Fea and Marlene Moster. Moderated by Pradeep Ramulu.

Q&A

Dr. Palmberg, what are the chances of bleb leak when we just snip a bleb overhanging the cornea with Vannas scissors at the slit lamp?

My experience was that only one of the first 13 cases leaked. From that leak case I realized that one needed to carefully examine the portion to be excised using a thin slit beam angled to the side to look for structure within the bleb. If the contents of the bleb was entirely hydrated Tenon’s capsule tissue, it is safe to excize without need for a horizontal compression suture. IF, on the other hand, the portion of the bleb to be removed is optically empty, thus just aqueous filled, a compression suture is placed before excision to prevent leak.

Dr. Palmberg, when doing compression sutures for a dysesthetic bleb, why don’t you use absorbable sutures since having to remove the nylon sutures a second time exposes the patient to a risk of infection?

None of the hundred or so patients in whom I placed nylon compression sutures for a painful bleb and covered them with Polytrim 4 times a day became infected. (One patient in whom I placed a stitch to wall off a lateral leak in a bleb and he did not use the prescribed Polytrim did get a bleb infection and endophalmitis.) The stitch is removed by cutting it with a 30g needle on one side of the corneal portion and grasped at the other end of the corneal portion with Jeweler’s forceps and pulled out straight along the corneal surface (not lifting up). In that way bleb leaks were avoided.
I used nylon since it does not stimulate inflammation, as does vicryl, and the goal is to stimulate the formation of collagen cords in the bleb, not to cause inflammation, which could affect bleb function. Also, braided vicryl would likely abraid the conjunctiva, which could cause a leak. Also, one want the suture to last up to 3 weeks, and vicryl on the surface might be digested before the desired effect occurs. However, in one case, when a patient told me he could not return for follow up as he needed to return to Haiti immediately, I did use a monofilament 8-0 vicryl compression suture, but I have no follow up.

Dr. Khaw, when performing trabeculectomy, does the site (Superior / Superionasal) and number of clock hours of conj-tenon’s dissection influence the occurrence of dysesthesia?

If the superonasal is too near the lid margin then the bleb will more likely be interpalpebral with dysaesthesia. Minimise the anterior clock hour dissection and maximise the posterior pocket to achieve diffuse non-dysaesthetic blebs.

Dr. Khaw, what do think is the main contributing factor to bleb dysesthesia?

Dysaesthesia is mainly caused by the bleb position (interpalpebral and anterior= worse) and the shape of the bleb (high with cystic components). This has effects on the tear film, conjunctival and cornea nerves and sensation causing dysaesthesia. A posterior diffuse bleb under the lid is generally a very comfortable bleb.

Dr. Buys, is your approach to bleb dysesthesia the same if the eye is also hypotonous?

The combination of bleb dysethesia and hypotony typically will require an intervention and on a more urgent basis specifically if vision is affected and/or there is evidence of hypotonous maculopathy. First look for a bleb leak or sweating. In this case address the bleb. Typically they are avascular blebs so suturing or gluing the leak is unlikely to work. One could also consider an autologous blood injection. The definitive approach is to replace the conjunctive either with a pulldown or a conjunctival transplant. If the conjunctive is intact, then the problem is aqueous getting out of the eye from the scleral flap. My suggestion in this scenario is transconjunctival resuturing of the scleral flap. This requires that you can see the sclera. Typically several sutures are required.

Dr. Sheybani, in the case you presented, where a small capsulorhexis had been completed by the outside doctor, but the case aborted because of severe zonular instability, why did you not enlarge the small continuous capsulorhexis?

There was already phimosis forming. Cornea was too cloudy to rush in to surgery so this was 3 weeks after phaco. Concern is that if there is phimosis, it might not tear without running out.

Dr. Sheybani, what nuclear disassembly technique do you favor in an eye with zonular weakness from PXF?

Whichever technique you’re most comfortable with. I prefer horizontal chop for most lenses. A combination of sculpt and chop if the lens is very very dense. I usually do a hemi flip technique.

Dr. Sheybani, what about doing an ICCE and putting an AC IOL (angle or iris supported) in a patient with significant subluxation?

Definitely an option! Keeping the bag is more critical of your wanting to do a mfiol or toric.

Dr. Moster, how do you cortical clean-up in PXF eyes without creating further problems? Any specific technique to remove PXF material?

I do cortical cleanup with a silicon (white tip on the alcon i/a) and pull the cortex east to west or west to east without removing it radially toward the middle like i usually do. I also go close to the angle when removing the visco, and if the bag is stable use a silicon squeegee tip to clean under the anterior capsule ring so as to remove as much psxf as possible. I like to leave the capsule and the angle without any debris.

Dr. Moster, do you ever consider an IOP-lowering procedure in PXF, even if the pressure is not yet high?

Good question. I must say I don’t see many of those as I am a tertiary referral. However, if the iop is normal, the vf, oct, pacy, historesis, family hx, is all normal, I think a perfect phaco, with excellent bag clean up, especially under the anterior capsule ring, and good removal of the visco from the angle is all you will need. Basically, if it isn’t broken, don’t fix it!

Dr. Fea, what is the ideal time to put in a capsular tension ring?

The general suggestion is to implant as late as possible, because the CTR can make the aspiration of cortex more complex, but the final decision is mainly a matter of “feeling” and experience. Especially in subluxated cataracts the posterior capsule can move much more towards the aspiration tip, so in case you feel not at ease, it is definitely better to work a little more and have an intact capsule than to have a subluxated lens with a broken capsule.

We advocate for policy change by telling the stories of persons living with glaucoma.

As the Global Glaucoma Network, the WGA is the prime organization to bring these stories together and help you plan and execute a successful glaucoma awareness campaign in your local community.

This Glaucoma Awareness Slide Deck is designed by the Advocacy Committee for our glaucoma society members to showcase the silent thief of sight and educate policymakers about the critical funding issues glaucoma research faces.

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The World Glaucoma Association is launching a new series of webinars focused on surgical challenges that glaucoma specialists are likely to face: WGA Surgical Grand Rounds. Each 1-hour webinar will feature two scenarios of surgical challenges or complications. After each presentation, the speaker will join an expert panel for a brief discussion and answer questions related to the presentation. Get ready for state-of-the-art surgery videos and discussions from the world’s most skillful glaucoma surgeons!

Join us at the first-ever edition of the WGA Surgical Grand Rounds on Thursday, January 27, 2022, in 3 easy steps:

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Join one of the two broadcasts!

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World-renowned glaucoma specialists share how they approach surgical challenges.

Program Thursday, July 7

Mark your calendar for another great Surgical Grand Rounds, where the following two topics will be discussed:

Malignant Glaucoma presented by Leon Au, MD (United Kingdom). Panelists: Harry Quigley, MD (United States) and Esther Hoffmann, MD (Germany). Moderated by Tanuj Dada, MD (India).
Nanophthalmos with Glaucoma presented by Shamira Perera, MD (Singapore). Panelists: Sharmila Baburajendran, MD (India) and Mohammed Pakravan, MD (Iran). Moderated by Pradeep Ramulu, MD (United States).

The webinar will be broadcast live at two timeslots, making sure that wherever you are, you can tune in at a time that suits you.

8 am UTC | find your local time here
3 pm UTC | find your local time here

💻On-demand Replay

Watch the Surgical Grand Rounds on-demand, as many times as you want with your free WGA#One Account.

Watch the January 27 replay
Watch the April 14 replay

About the Surgical Grand Rounds

This year the WGA launched a new webinar series, focused on surgical challenges that glaucoma specialists are likely to face: WGA Surgical Grand Rounds. Each webinar features two scenarios of surgical challenges or complications. After each presentation, the speaker joins an expert panel for a brief discussion and answers questions related to the presentation. Get ready for state-of-the-art surgery videos and discussions from the world’s most skillful glaucoma surgeons!

Meet the Experts

Tanuj Dada, MD (India)

Dr Tanuj Dada is a Professor of Ophthalmology and Head of Glaucoma Services at the RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. He currently serves on the Board of Directors of the Asia Pacific Glaucoma Society, as Secretary of the International Society of Glaucoma Surgery and is a member of the Education & Consensus Committees of the World Glaucoma Association. He is an Associate Editor for the Journal of Glaucoma, Chief Editor of the Journal of Current Glaucoma Practice and on the Editorial Board of the American Journal of Ophthalmology.

Moderator

Pradeep Ramulu, MD (United States)

Dr Pradeep Ramulu is the Sheila K. West Professor of Ophthalmology at the Johns Hopkins Wilmer Eye Institute, where he directs the Glaucoma division. Using many tools including patient-reported outcomes, observation of task performance, and real-world behavioral monitoring, Dr. Ramulu has helped define when, how, and why visual impairment results in disability. He currently serves as chair of the American Glaucoma Society Program Committee and the Glaucoma Research Society Program Committee and heads the World Glaucoma Association Education Committee.

Moderator

Leon Au

Leon Au, MD (United Kingdom)

Mr Leon Au is a Consultant Ophthalmic Surgeon specializing in glaucoma and cornea. He graduated from the University of Nottingham in 1998 with an ophthalmology prize of the year. He completed 8 years of general ophthalmology training in Nottingham and Manchester before undertaking separate subspecialty training fellowships in cornea, glaucoma and refractive surgery. He has been a dual-specialty consultant in the Manchester Royal Eye Hospital since February 2009. He is an international leader in the field of innovative glaucoma surgeries and is involved in many of the clinical trials.

Presenter

Shamira Perera, MD (Singapore)

Assistant Prof Shamira Perera is a Senior Consultant Ophthalmologist in the Glaucoma Service at SNEC with an interest in novel surgeries and imaging. At SERI he is the Co Head of Bioengineering and Devices works closely with Business Development team to commercialize devices in glaucoma and cataract eg Spiralis to Geuder. His most recent role as the deputy director of the Med Tech office for SingHealth seeks to promote this promising area to other specialties and has disbursed >S$6M for innovation. Together these roles allow him to pursue his interests in surgical devices, biomechanics and imaging.

Presenter

Harry Quigley, MD (United States)

Dr. Quigley, the A. Edward Maumenee Professor, Wilmer Eye Institute, Johns Hopkins, has been CEO of ARVO and Editor-in-chief of IOVS. His research improved glaucoma diagnosis of glaucoma, was first to report on success with laser iridotomy and his trabeculectomy suturing technique was widely adopted. He pioneered studies of glaucoma epidemiology, conceptualized the roles for iris and choroid in angle closure, performed the first neuroprotection gene therapy, and initiated scleral neuroprotection research and developed glaucoma models in monkeys, rats and mice.

Panelist

Esther Hoffmann, MD (Germany)

Esther M. Hoffmann holds a professorship for glaucoma at the Department of Ophthalmology in Mainz, Germany. She is furthermore the head of the German Childhood Glaucoma Center at the University Medical Center. She is a clinical scientist in the field of childhood glaucoma surgery, imaging and early detection of glaucoma. She has won several prizes and has published over 130 peer-reviewed manuscripts on glaucoma. She is Head of the Glaucoma section of the German Ophthalmological Society (DOG).

Panelist

Sharmila Baburajendran, MD (India)

Dr. Sharmila is currently serving as a senior Glaucoma Consultant at Aravind Eye Hospital with more than 15 years of clinical experience. She is also the member secretary of the Institutional review board of Aravind Eye Hospital, Madurai. Dr. Sharmila has been actively involved in several Clinical and Research trials and has published more than 40 articles in peer-reviewed Journals and co-authored several textbooks. Her areas of interest are managing Nanophthalmos, Paediatric and Refractory Glaucoma.

Panelist

Mohammed Pakravan, MD (Iran)

Born and raised in Tehran, Iran, Dr Pakravan is currently a faculty member at the Glaucoma and neuro-ophthalmology department of the University of Arkansas Medical science. Dr Pakravan was previously a faculty member of the ophthalmology department at Shahid Beheshti University in Iran, completed a neuro-ophthalmology fellowship with Dr. Cameron F. Parsa in Tehran, a combined neuro-ophthalmology / glaucoma fellowship with Dr. Neil R. Miller and Dr. Harry A. Quigley at the Wilmer Eye Institute and a neuro-ophthalmology fellowship with Dr. Andrew G. Lee at Methodist hospital, Houston, Texas.

Panelist

Future Surgical Grand Rounds

Save the date for the final Surgical Grand Rounds in 2022: October 27.

The ‘Fundamental Questions in Glaucoma’ video series is here! Powered by WGA’s Education Committee and featuring easy-to-digest video content, this brand new series of lectures is great for everyone who wants to learn more about glaucoma in minutes.

About the Fundamental Questions in Glaucoma lectures

The Fundamental Questions in Glaucoma is a series of Audio-Visual Modules initiated by the Education Committee of the World Glaucoma Association. These include video-assisted skill transfer on basic techniques of glaucoma lasers and surgery for trainee ophthalmologists, as well as frequently asked questions regarding the diagnosis and management of glaucoma patients.

Expect answers to questions such as:

What is the best way to examine the optic nerve for early detection of glaucoma?
What visual field testing strategy should I use?
How is Suturolysis best performed?
How do I perform a selective laser trabeculoplasty for Primary Open Angle Glaucoma?

and much more!

What makes this series of lectures different than others?
Materials submitted by speakers were reviewed by both of the editorial leads, Drs. Tanuj Dada and Pradeep Ramulu, and at least 2 Education Committee members. Thus, these lectures, unlike others have undergone a formal peer review for content completeness and accuracy.

Get access to the key glaucoma insights and view all Fundamental Questions in Glaucoma lectures directly below!

To download the lecture slides and find more information on the lectures and their presenters, go to the WGA Video Library. All you need to do is log in to your WGA#One account or create a free account.

Access lectures in WGA Video Library Create a WGA#One account

How can I tell if a visual field is reliable? | Harsha Rao[06:57]

Deciding the reliability of a visual field is a challenging task mainly due to the subjective nature of the test. Although the visual field report comes with a number of reliability indices, it is known that these reliability indices provide some indication on the reliability of the test but would not provide the complete information … Continue reading

How do I implant a non-valved glaucoma drainage device? | Keith Barton[10:00]

Keith Barton describes his technique of Baerveldt 101-350 insertion with tips and tricks for optimal results.

How do I needle an encysted/failing filtering bleb? | Vital Costa[07:57]

Needling is a procedure commonly used to restore the function of encysted or failing blebs. This video will describe the surgical technique of this procedure, the expected success rates and its complications. After the placement of a lid speculum, the eye is dislocated downwards with the help of a cotton tip or a 7-0 vycril … Continue reading

Postoperative shallow anterior chamber | Sirisha Senthil[06:58]

Trabeculectomy is often associated with postoperative intraocular pressure-related or bleb-related problems. They need to be identified and treated appropriately to preserve the bleb function and prevent serious sight-threatening complications. A common postoperative complication after trabeculectomy (and other drainage surgeries) is shallow anterior chamber, which can be associated with hypotony or high IOP and result from … Continue reading

My glaucoma patient has a visual handicap with severe visual field damage. How can I help them? | Kelly Muir[06:02]

In this talk, Kelly Muir will discuss how we can help our patients with severe visual impairment in our role as the glaucoma physician and also in our role and referring doctor, in collaboration with colleagues in complimentary fields.

Which angle closure eyes benefit from lens removal/cataract surgery? | Augusto Azuara-Blanco[06:22]

This video describes current evidence regarding the role of lens extraction in patients with angle closure. In brief, patients with co-existing angle closure and cataract will benefit from early lens extraction. For those patients with clear lens and significant angle closure disease there is evidence that phacoemulsification is more effective than peripheral laser iridotomy. Combining … Continue reading

How do I treat a bleb-related inflammation? | Vijaya Lingam[06:05]

Bleb associated infection (BAI), found most commonly in thin cystic blebs, is a vision threatening complication after Trabeculectomy. There are three stages of BAI: stage I – blebitis with inflammation confined to bleb, stage II – blebitis with associated anterior chamber reaction but no vitritis, and stage III – blebitis complicated with vitritis. In order … Continue reading

How can I tell if an OCT is reliable? | Donald Hood[05:21]

There are four reasons given as to why the OCT may not accurately reflect a particular patient’s level of damage. Each is only partially true. First, it is believed that arcuate-like artifacts on OCT maps from healthy eyes can be confused with arcuate defects due to glaucoma. In fact, arcuate-like artifacts can be distinguished from … Continue reading

Is glaucoma an asymptomatic disease, or are there visual symptoms? | Pradeep Ramulu[05:36]

While there are many methods too ascertain the severity of glaucoma with various forms of testing (clinical exam, visual fields, OCT imaging), direct patient communication can also help understand the extent to which a patient with suspected or known glaucoma is affected by their disease. In this video and its summary, we discuss at what … Continue reading

Surgical management of nanophthalmos with angle-closure glaucoma | Sharmila Rajendrababu[10:21]

Nanophthalmos is a rare disease with crowded anterior segment and increased scleral thickness. Surgery in Nanophthalmos is often prone for Vision threating complications like Uveal effusions and retinal detachment. Careful pre-operative planning and intraoperative Prophylactic Selerostomy may minimize the risk of complications. This presentation is meant to provide an overview and practical tips for safe … Continue reading

Classification of Angle Closure | Tin Aung[04:49]

Primary angle closure occurs when there is an anatomical obstruction of the aqueous humor outflow by the iris without a secondary pathological cause. We can identify several stages of the disease defined by the presence of certain structural and functional characteristics that define each stage. The stages have been termed as follows: Primary Angle Closure … Continue reading

How do I perform a non-penetrating glaucoma surgery? | Alain Bron[09:44]

In this presentation, you will find all the details on how to perform deep sclerectomy, one of the procedures for non-penetrating glaucoma surgery. This surgery is designed for open angle glaucomas and offers a much safer profile than trabeculectomy. However, the IOP-lowering effect is a bit less than trabeculectomy. The procedure does not require any … Continue reading

How do I teach a patient about how to put in eye drops? | Kessara Pathanapitoon[04:13]

One of the factors that is negatively correlated with adherence to topical glaucoma therapies is difficulty in applying drops. Only a small number of patients can correctly administer exactly one drop without touching the eye. Patients with more years of experience or given better education were likely to instill a single drop and have the … Continue reading

How should I treat glaucoma in pregnant and lactating patients? | Yvonne Buys[05:34]

There are multiple challenges and uncertainties related to the management of glaucoma management in women planning a pregnancy, during pregnancy, and during the breastfeeding period. The approach to treatment must be individualized considering the risks of treatment to both the mother and the fetus versus the risk of vision loss for the mother. It is … Continue reading

How do I perform a Selective Laser Trabeculoplasty for Primary Open Angle Glaucoma? | Tony Realini[07:17]

In this presentation, I will share my approach to SLT in patients with POAG, including patient selection, the equipment and supplies I prefer, my technique, and post-procedure care.

Tips for intraoperative gonioscopy and how to perform goniosynechiolysis | Kazuhiko Mori[08:46]

Increasingly, glaucoma specialists require expertise in surgical gonioscopy, as lots of MIGS procedures with ab interno approaches utilize a surgical goniolens. Goniosynechialysis (GSL), which physically separates peripheral anterior synechiae from trabecular meshwork, also utilizes surgical goniolens. There are two types of surgical goniolens; direct type and double mirror type. Direct gonioprisms which have been widely … Continue reading

What visual field testing strategy should I use? (SITA Standard/Fast/Faster 30-2/24-2/24-2C) | Anders Heijl[05:56]

This video will discuss choosing SITA tests for glaucoma management. Original SITA Standard and SITA Fast strategies represented a change of paradigms: time-saving, very computer-intensive with maximum likelihood estimations in real time. SITA Faster is a further development of SITA Fast. Definitively detecting perimetric progression and measuring rate of progression usually requireat least 5 tests. … Continue reading

How is Suturolysis best performed? | Eytan Blumenthal[07:15]

Suturelysis (SL) is a powerful and relatively simple procedure enabling the opening of scleral flap (sub-Tenon) sutures utilizing an Argon-like (green) laser. It increases flow across the trabeculectomy fistula thus lowering intraocular pressure. During trabeculectomy, a scleral flap is created, which, if left unsutured, would flatten the anterior chamber and collapse the eye. Well-placed sutures … Continue reading

What is the best way to examine the optic nerve for early detection of glaucoma? | Remo Susanna[06:18]

The optic nerve examination is the most important component of the evaluation of a glaucoma patient. The appearance of the optic nerve can assist with diagnosing glaucoma and detecting its progression. It is irreplaceable in detecting nonglaucomatous causes of ONH cupping and visual field defects similar to those in glaucoma. A systematic process of disc … Continue reading

How do I perform a fornix based Trabeculectomy? | Fabian Lerner[07:01]

In this short video, I present my surgical technique of fornix-based trabeculectomy, step-by-step. No traction suture is used in cooperative patients. The conjunctiva is incised 1 mm from the limbus. After enlarging the incision, sub Tenon´s dissection is performed. One or more sponges soaked in a Mitomycin C (MMC) solution are applied. Cell sponges absorb … Continue reading

How do I perform the Ahmed glaucoma valve implant surgery? | Joseph Anthony Tumbocon[07:45]

Ahmed glaucoma valve surgery is usually indicated in patients that have a higher risk for failure with trabeculectomy with mitomycin or other types glaucoma surgeries. It allows immediate and controlled intraocular pressure (IOP) reduction in eyes with medically uncontrolled IOP with less risk for hypotony. A detailed step-by-step guide on conventional Ahmed glaucoma valve surgery … Continue reading

How do I perform a fornix based Trabeculectomy? | Sir Peng Khaw[08:37]

In this presentation, I describe how I carry out a fornix based trabeculectomy. The different surgical principles established through research and subsequent components of this operation have evolved into the ”Moorfields Safer Surgery System” which has increased the safety of trabeculectomy, particularly with the use of antimetabolites. The different antimetabolites and uses apart from sponge … Continue reading

Role of meditation and YOGA in glaucoma patients | Tanuj Dada[06:32]

YOGA is a mind-body intervention to achieve holistic health with key components including physical postures, breathing exercises, and meditation. While head-down physical postures can lead to a significant spike in IOP, recent studies indicate that mindfulness meditation focused on the breath may be a useful adjunctive therapy, positively impacting the quality of life in glaucoma … Continue reading

Editorial Leads
Tanuj Dada (IN), Pradeep Ramulu (US)

Editorial Team
Deus Bigirimana (AU), Eytan Blumenthal (IL), Maria Carrasco (AR), Irene Copati (AR), Gustavo De Moraes (US), Ronnie George (IN), Carolina Gracitelli (BR), Marcelo Hatanaka (BR), Parul Ichhpujani (IN), Ingrida Januleviciene (LT), Christopher Leung (HK), Monisha Nongpiur (SG), Olusola Olawoye (NG), Zeynep Ozturker (TR), Rajul Parikh (IN), Harsha Rao (IN), Lisandro Sakata (BR), Chelvin Sng (SG), Min Hee Suh (KR), Xinghuai Sun (CN)

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Create a free WGA#One account to join the largest international glaucoma network.

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

Login

WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

info@worldglaucoma.org

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

Create a free WGA#One account to join the largest international glaucoma network.

If you need assistance, please contact the WGA Executive Office at

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WGA#One is your gateway to the World Glaucoma Association. With a WGA#One account you can access knowledge resources and join our community.

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💻 On-demand replay WGA Surgical Grand Rounds

Program February 27, 2022

Q&A

Dr. Palmberg, what are the chances of bleb leak when we just snip a bleb overhanging the cornea with Vannas scissors at the slit lamp?

Dr. Palmberg, when doing compression sutures for a dysesthetic bleb, why don’t you use absorbable sutures since having to remove the nylon sutures a second time exposes the patient to a risk of infection?

Dr. Khaw, when performing trabeculectomy, does the site (Superior / Superionasal) and number of clock hours of conj-tenon’s dissection influence the occurrence of dysesthesia?

Dr. Khaw, what do think is the main contributing factor to bleb dysesthesia?

Dr. Buys, is your approach to bleb dysesthesia the same if the eye is also hypotonous?

Dr. Sheybani, in the case you presented, where a small capsulorhexis had been completed by the outside doctor, but the case aborted because of severe zonular instability, why did you not enlarge the small continuous capsulorhexis?

Dr. Sheybani, what nuclear disassembly technique do you favor in an eye with zonular weakness from PXF?

Dr. Sheybani, what about doing an ICCE and putting an AC IOL (angle or iris supported) in a patient with significant subluxation?

Dr. Moster, how do you cortical clean-up in PXF eyes without creating further problems? Any specific technique to remove PXF material?

Dr. Moster, do you ever consider an IOP-lowering procedure in PXF, even if the pressure is not yet high?

Dr. Fea, what is the ideal time to put in a capsular tension ring?

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Program Thursday, July 7

💻On-demand Replay

About the Surgical Grand Rounds

Meet the Experts

Tanuj Dada, MD (India)

Pradeep Ramulu, MD (United States)

Leon Au, MD (United Kingdom)

Shamira Perera, MD (Singapore)

Harry Quigley, MD (United States)

Esther Hoffmann, MD (Germany)

Sharmila Baburajendran, MD (India)

Mohammed Pakravan, MD (Iran)

Future Surgical Grand Rounds

About the Fundamental Questions in Glaucoma lectures

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