Education Committee Highlights WGC-2019 – part 3

The Education Committee carefully selects presentations from the WGC-2019 for your benefit. This month Maria Carrasco introduces the sessions: Angle Closure: Diagnosis and Treatment, Getting care to those who need it and Tube complications.

Angle Closure: Diagnosis and Treatment

By 2040, 32 million individuals will have angle-closure glaucoma (ACG), and half of those blind from glaucoma will have angle closure. Sometimes doctors suspect an angle closure based on the presence of symptoms but they failed to identify a large number of asymptomatic patients and people at risk.  The term “glaucoma” is currently used indiscriminately, regardless of the presence or absence of optic neuropathy and vision loss. Angle closure is defined by irido-trabecular contact.  It is important to know the prevalence in your region and to be able to identify at-risk populations by watching the presentation by Dr. Paul Foster.

There are several angle-closure mechanisms that play a role in causing anatomical angle-closure. These include pupillary block, iris, and ciliary body abnormalities, lens-related causes, as well as causes that are located behind the lens.  On Diagnosing Angle Closure: Is gonioscopy the gold standard for angle evaluation yet? Why is indentation gonioscopy crucial in angle closure disease? What are the advantages and disadvantages of imaging tools like Anterior Segment OCT or UBM?  Find out by watching Dr. George’s presentation.

The management of primary angle closure may be challenging. Laser peripheral iridotomy is widely used to treat angle closure.  Dr. Chan emphasizes that a clear lens is not equal to a normal lens and proposes that clear lens extraction is a viable treatment option for angle closure.  In addition, Dr Chew presented the tips and pearls to perform a safe clear lens extraction.

Dr. Pakravan discusses secondary angle closure in different scenarios. He also mentions that aqueous misdirection syndrome can occur in eyes undergoing surgery for angle-closure and revises its mechanism and its management.

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Getting care to those who need it

People afflicted with glaucoma and living in developing countries are at a particular disadvantage; they have a higher risk of progressing to blindness and present with more advanced disease. Dr Olivier shows her experience in Haiti and remarks the importance of training the trainers and continuing education programs.

There are several challenges that exist in the approach to glaucoma in the developing world: glaucoma awareness, adherence to treatment and access to care. Dr Sihota advocates and implements a national glaucoma program in India. Learn from her experience!

Dr Friedman addressed how to use of low cost fundus imaging to detect glaucoma. Other presentations show the scenarios in China and Africa.

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Tube complications

Since the publication of the Tube versus Trabeculectomy Study clinical trial, tube shunt implantation is more common considered as a surgical option to lower intraocular pressure.

Complications in tube shunt surgery are not uncommon. The early postoperative complications are similar to other filtration procedures including flat chambers, choroidal effusion, hypotony and hyphema. In addition, you may find Tube-Related Problems (tube exposure, tube occlusion and tube malposition) or Plate-Related Problems (diplopia, ptosis, etc).

Tube shunts produces continuous endothelial cell damage. Which is the key factor involved:  the distance between the tube and the endothelium, the tube-cornea angle, the movement or the length of the tube? Find the answer watching the presentation of Dr. Lim.

Tube erosions have decreased since the use of scleral tunnel, this technique is costless and immunologically safe. Detecting risk factors may prevent this complication. Learn about it during Dr. Rolim presentation.

High IOP or Low IOP: A good review of the factors related to hypertensive phase after glaucoma tube shunt is showed in the lecture of Dr. Freedman. The role of high IOP and cytokines is discussed. Incidence, risk factors, prevention and treatment of Hypotony are presented by Dr. Lu.

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