SURGICAL CHALLENGES IVE READ THIS ARTICLE IN GLAUCOMA TODAY JOURNAL,ANY COMMENTS ABOUT HOW TO REPAIR THE CHRONIC POST GLAUCOMA SURGERY HYPOTONY TO GET RID OFF THESE DIFFICULTIES DURING CATARACT SURGERY??? Intraoperatively, soft eyes can be challenging; creating incisions may be awkward. a steeper, firmer attack is more effective and will result in less distortion of the globe. Pressurizing the eye with viscoelastic is helpful; however, great caution is warranted in truly hypotonous eyes, as deepening the chamber too much with excessive viscoelastic will make surgery more difficult and may compromise the lens’ stability. Given the possibility of a soft eye postoperatively coupled with the potentially imperfect construction of the clear corneal wound in a soft eye, it is reasonable for the surgeon to suture the wound to ensure it is tightly closed in the early postoperative period. In many cases, cataract surgery may provide just enough stimulation to slightly shrink the bleb and produce a slightly higher IOP. Some blebs will fail following cataract surgery with loss of control of IOP. This may be more likely if cortical material is left behind. In some eyes, however, the pressurization of the eye during phacoemulsification may lead to an enlargement of a bleb that may be persistent. This process can create hypotony in filtered eyes that were not previously hypotonous, may worsen existing hypotony, or can rarely lead to chronic bleb dysesthesia from the larger bleb. If the bleb significantly enlarges during cataract surgery, a lower bottle height may be beneficial in reducing these sequelae, although this will be less effective in counteracting the difficulties of working on a soft eye . >>. Surgical correction of the hypotony prior to cataract surgery removes many of these uncertainties. Changes in corneal and axial length are most profound with very low pressures, so achieving an IOP even in the low normal range may significantly improve outcomes. This entails two surgeries, however, and the cataract surgery may further change the final IOP. On the other hand, if surgical repair of the hypotony should lead to loss of IOP control, then the planned subsequent cataract surgery may be combined with intervention to lower the IOP again. IVE READ THIS ARTICLE IN GLAUCOMA TODAY JOURNAL,ANY COMMENTS ABOUT HO
Posted on: Fri, 14 Mar 2014 18:43:24 +0000