Hypotony after trabeculectomy: don't stop anti-inflammatory drops & don't operate if post-op care inadequate.

Hypotony after trabeculectomy: don't stop anti-inflammatory drops & don't operate if post-op care inadequate.

The trabeculectomy involves creating a trap-door in the sclera underneath the upper lid. The goal of the follow-up care is basically to make sure that this trap door never heals properly so that it is leaking out a small amount of aqueous humour to the overlying conjunctival layer to lower the pressure inside the eye. It is vital that aggressive anti-inflammatory treatment be maintained in the early post-operative period to prevent proper healing. Unfortunately, sometimes my colleagues alter the originally planned post-operative regiment of aggressive steroid drops when they encounter too low a pressure or a shallow anterior chamber and jeopardize the chance of longterm success.

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Trabeculectomy in patient with prior vitrectomy: helpful hints?!

Trabeculectomy in patient with prior vitrectomy: helpful hints?!

I frequently encounter patients who have had multiple prior intraocular surgeries and are in need of glaucoma surgery. Although tempting to jump right to a glaucoma drainage implant, would it be possible in certain patients to opt for a mitomycin trabeculectomy and save the glaucoma drainage implant if really needed at a later date?

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Mini neuropatties for mitomycin Trabeculectomy to avoid retained foreign body (video)

Mini neuropatties for mitomycin Trabeculectomy to avoid retained foreign body (video)

A couple of months ago, when I could not find one of the two mitomycin soaked 8x8mm instrument wipe sponges I had placed in the sub-tenon’s space, the first time this has happened in an estimated 2,000 surgical cases over 16 years, I thought…well, this won’t ever happen again. When it happened again a couple of weeks ago; I knew that it was time to change my technique of mitomcyin application.

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Keynote talk on the optic nerve in glaucoma

Keynote talk on the optic nerve in glaucoma

Here is a video of the slides used from the 19Feb2010 discussion with our residents at UBC on the optic nerve in glaucoma. This was designed as an interactive discussion with the residents asked to read in advance pages 47-61 of the American Academy of Ophthalmology BCSC manual on glaucoma, two references by Stephen Drance et al on the clinical appearance of the optic nerve, and a chapter in Fingeret, Flanagan, and Liebmann’s “The Essential HRT Primer” discussing progression. 

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Under-serviced? How about over-doctoring being the problem here?

Under-serviced? How about over-doctoring being the problem here?

Here’s a problem that goes against the common mis-perception about practicing medicine in Canada. While we often hear false allegations from mostly Republicans in the United States that there is inadequate access to medical care in Canada, I have found out recently that many of my patients are over-doctoring.

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Would you just observe glaucoma patient with IOP of 39mm Hg?

Would you just observe glaucoma patient with IOP of 39mm Hg?

I was sure I would not tweet any consults from this day as I still had many cases that I wanted to write about in greater detail here on my blog, but I couldn’t resist tweeting and now talking more about this particular patient presenting with rather high intraocular pressure but no other risk factors for glaucoma.

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