Efficacy of Punch Trabeculectomy in different typesof Glaucoma

Dr. Anand Sudhalkar

Baroda.

IOP & Glaucoma management

IOP the only Modifiable risk Factor

Relationship of the two well established(1,2)

Establishing an Effective Target IOP the Key in management(3)

Aim of glaucoma management is to maintain IOP below the Target to reduce field loss and improve optic nerve circulation(4)

Ref 1. R. Vogel et al.BJO 1983; vol 67, 220-227, Ref 2. G. Gazzard BJO 2003;

Ref 3. Popovi. Coll Antropol 2005; 29 Suppl 1:149-51.

Ref 4. Anders Heijl. Arch Ophthalmol. 2002; 120:1268-1279.

Modalities for IOP reduction

Topical drops

Laser Trabeculoplasty

Laser PI

Filtration Surgery

Material & Classification

46 eyes of 41 patients

POAG – 22

PNAG – 19

ACUTE CONGESTIVE – 5.

WORKUP

Complete eye examination

Gonioscopy

Applanation tonometry

Autoperimetry (Octopus)

Baseline & Target IOP

Mean of diurnal IOP at 9am, 3pm and 8 pm.

Target IOP derived individually considering

Baseline IOP(5)

Ref 5 Sonal D. Wadhwa Comp Ophthalmol Update 6: 259-65, 2005

Further adjustments to Target IOP

Hartleben Formula

Dynamic adjustments after follow up fields

using Visual Field Scoring methods(6)

Ref 6 Brenda W. Gillespie (Investigative Ophthalmology and Visual Science. 2003; 44:2613-2620.)