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Education Committee Highlights WGC-2017 -part 6

Marcelo HatanakaThe Education Committee carefully selects presentations from the World Glaucoma Congress 2017 in Helsinki for your benefit. This month Marcelo Hatanaka introduces the sessions Grand Rounds and Hot debates in glaucoma – in honour of Juhani Airaksinen.


Grand Rounds

 

Cyclodialysis cleft treatment: how to preserve conjunctival filtration?

Stefania Piludu

Stefania Piludu presented a case of hypotony and anterior chamber shallowing after an ab-interno anterior chamber-subconjunctival shunting with XEN implant. A cyclodialysis cleft was detected. In this case, what are the treatment options and what do you expect in terms of IOP control? Find out by watching her presentation.

 

Sudden visual scotoma in a woman with exfoliation glaucoma

Luis Silva

What may explain the sudden appearance of central scotoma in one eye with pseudo-exfoliation and ocular hypertension after pupillary dilation? This case presentation, by Luis Silva, will bring you one possible explanation. Watch the video and learn more about paracentral acute middle maculopathy (PAMM).

 

Internal carotid artery aneurysm simulating normal tension glaucoma

Mario Pincelli Netto

In this case presentation, Mario Pincelli Netto brings one case of a 48 yo female patient, who complains of low vision acuity and headache for the last 2 years. OCT and fundus photography reveal unilateral retinal nerve fiber layer defect, with corresponding visual field defect. Since she did not present elevated IOP, normal tension glaucoma (NTG) seemed to the most possible diagnosis. . . until a MRI scan was performed. NTG: what to consider in the differential diagnosis?

 

An interesting case of angle closure glaucoma

Ayyappa Reddy Mallidi

Only seeing eye, uncontrolled angle closure glaucoma, no response after peripheral iridotomy and choroidal effusion after trabeculectomy. What else could go wrong? Six months after a succesful choroidal drainage, Dalen-Fuchs nodules were detected on fundus examination. Possible causes and treatment were presented.

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Hot debates in glaucoma – in honour of Juhani Airaksinen

 

With recent advances in optic nerve imaging, I believe that baseline optic nerve stereo photos are still essential

George Spaeth

Despite the difficulties related to learning glaucomatous optic disc patterns, optic disc evaluation and high quality photos are still the most valid and relevant method for diagnostic and follow-up purposes, according to Professor George Spaeth. Access this video to understand why.

 

With recent advances in optic nerve imaging, I believe that baseline optic nerve stereo photos are now unnecessary

Felipe Medeiros

In contrast to George Spaeth, Felipe Medeiros was asked to explain why stereo photos are now unnecessary. From the difficulties related to how to evaluate digital photos, to the lack of quantitative assessment of rates of change, this lecture provides more information on this topic.

 

In a patient with open angle glaucoma, a concurrent diagnosis of moderate to high myopia: does not fundamentally influence diagnosis and treatment

Tin Aung

Myopia is considered a confounding factor for glaucoma diagnosis. However, this may not be the case if clinical judgement and risk-factors assessment are taken into account.Tips on how to evaluate optic nerve heads, imaging tests, visual fields, as well as how to manage glaucoma in this scenario were presented in this lecture.

 

In a patient with open angle glaucoma, a concurrent diagnosis of moderate to high myopia: influences diagnosis but not treatment

Ki Ho Park

In addition to Tin Aung’s presentation, Ki Ho Park was asked to present some evidences to explain why moderate to high myopia may influence diagnosis, but NOT treatment. According to this presentation,disc tilt, peripapillary atrophy, choroiretinal atrophy, eyeball elongation may influence not only the first evaluation, but also the detection of progression. On the other side, evidences emphasizing the lack of the influence of myopia on medical treatment were presented.

 

In a patient with open angle glaucoma, a concurrent diagnosis of moderate to high myopia: influences both diagnosis and treatment

Robert Chang

Food for thought! As opposed to Tin Aung and Ki Ho Park presentations, Robert Change presented evidences to explain why moderate to high myopia may influence both diagnosis and treatment. From difficulties related to optic disc evaluation, OCT and visual field limitations, this lecture also deals with possible surgical complications related to the myopic condition of the eye.

 

In 5 years, the most successful glaucoma drug delivery system will be: extraocular IOP lowering drug delivery

Jamie Brandt

When thinking about glaucoma treatment, what can we expect for the near future? Watch this video to learn more about drug delivery systems. As presented by Jamie Brandt, non-adherent glaucoma patients represent a large unmet need. Considering that physicians are limited at identifying poorly-adherent patients, delivery systems – implantable or external – could be possible treatment options.

 

Non bleb forming MIGS surgery: is here to stay

Ike Ahmed

In terms of surgical treatment, Ike Ahmed presented some data to explain why not all glaucoma patients need high risk procedures to achieve the maximum IOP reduction. Concerning safety, said Ike Ahmed, MIGS, especially non bleb forming surgeries, are the choice to be considered, due to their safety, control, predictability and rapid recovery profile. More details on different devices were presented on this recorded lecture.

 

In a patient with well controlled mild glaucoma on one IOP lowering medication who requires cataract surgery I generally perform: cataract surgery alone

Fabian Lerner

Cataract surgery can reduce IOP. Thus, according to this lecture, from Fabian Lerner, in a patient with cataract and well controlled mild glaucoma on one IOP lowering medication, cataract surgery alone may be one therapeutic choice. Watch this video to further understand why, in this situation, phaco + MIGS combined procedure may not fulfill all the expectations in terms of IOP reduction.

 

In a patient with well controlled mild glaucoma on one IOP lowering medication who requires cataract surgery I generally perform: cataract surgery with a MIGs procedure

Julian Garcia Feijoo

In contrast to Fabian Lerner’s presentation, Julian Garcia Feijoo was asked to explain why phaco + MIGS combined procedure may be one surgical option to consider in a patient with cataract and well controlled mild glaucoma on one IOP lowering medication. Compliance, side effects, risk factors for medical therapy, quality of IOP control, were some of the arguments covered during this lecture. Watch both videos to know both sides of the history!

 

In 5 years, the go to surgical procedure in patients with advanced uncontrolled glaucoma will be trabeculectomy

Tanuj Dada

When thinking about other surgical options for glaucoma treatment, failure rates, complications and costs must be analyzed carefully. From micro-shunts to ab-interno anterior chamber-subconjunctival shunts, possible complications are explored in this lecture, which intended to present why trabeculectomy will still be the gold standard to surgical procedure in the next years.

 

In 5 years, the go to surgical procedure in patients with uncontrolled glaucoma will be a bleb forming procedure employing a device

Syril Dorairaj

Despite the benefits of trabeculectomy, post-operative care is the most important thing for this surgery. In order to improve surgical results, micro shunts may the solution to come. The results of such new devices to come were presented by Syril Dorairai.

 

In 5 years, the go to surgical procedure in patients with advanced uncontrolled glaucoma will be a non bleb forming procedure

Tarek Shaarawy

Still talking about the future, this lecture, presented by Tarek Shaarawy, presented surgical options that may be the treatment of choice, once we have managed wound modulation, perfected surgical techniques, and learned how to titrate cyclomodulation. Take a look at this video to know what we can expect for the next years!

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