This 50 y.o. patient underwent a trabeculectomy with mitomycin-C then developed progressive hypotony maculopathy as well as a cataract. After concluding the cataract portion of the surgery, I placed a suture through the conjunctiva and its underlying scleral flap supratemporally. This video shows this portion of the surgery.
Read MoreThere’s a new device available to help in the surgical management of patients with glaucoma: the Glaukos iStent. After implanting a pair of these in each of three patients, here are my initial thoughts along with links to some recent publications. I have also included a video of the second patient in whom I used these implants and several recent references on the device. The iStent was approved in Canada in April 2010 but still awaits FDA approval in the United States.
Read MoreThis aphakic patient presented with elevated intra-ocular pressure many years after Ahmed Glaucoma Valve implantation performed by a colleague of mine.
Read MoreFour recent glaucoma patients discussed in this article. ADDENDUM 08Oct2012: With the migration to the latest version of the Squarespace blogging platform, this is one of many of my articles that has been ruined as the images can no longer be clicked on to enlarge. It would take many more months to manually re-encode these articles so they are now here for historial purposes but not terribly useful with just thumbnails of the images. Future case presentations however will look really good with the updated feature set.
Read MoreThe 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.
Read MoreI 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?
Read MoreI started this site in 2009 to write about Glaucoma, Health IT (EMR, EHR), Technology and to host my podcast series "Talking About Glaucoma." There is a shortcut to this blog to make it easier to find http://iguy.tv/blog.
I am a glaucoma sub-specialized Ophthalmologist and have a full time clinical practice at the Dartmouth-Hitchcock Clinic of the Geisel School of Medicine in Hanover, NH. I have a longtime interest in the use of technology to help in medical care as well as in Education. In addition, I was a very early adopter and developer of Electronic Medical Record systems who has lectured internationally on the topic of making the transition to EMRs in daily practice.
Copyright © 2009-2018, Robert M Schertzer, MD, MEd, FRCSC. All rights reserved.
