190 likes | 334 Views
My Deep Sclerectomy is starting to fail. Jordi Loscos Arenas MD, PhD Hospital Universitari Germans Trias i Pujol Barcelona. Failure location. _ Ab externo: Slit lamp _ Ab interno: Gonioscopy _ Surgical area : AS-OCT. Ab externo failure. _ Subconjuntival filtration decreased.
E N D
My Deep Sclerectomy is starting to fail. Jordi Loscos Arenas MD, PhD Hospital Universitari Germans Trias i Pujol Barcelona
Failurelocation _ Ab externo: Slitlamp _ Ab interno: Gonioscopy _ Surgicalarea: AS-OCT
Ab externo failure _ Subconjuntivalfiltrationdecreased Non increased IOP _ Increase anti-inflamatory topical therapy _ Subconjunctival Dexamethasone _ Subconjunctival Bevacizumab _ Conjunctivalmycrocystsabsence _ Increasedvascularity _ Sealedsclerallips _ Flatteningbleb Increased IOP _ Needling MMC Always consider Goniopuncture !!!
Ab externo failure Needling with MMC Subconjunctival Bevacizumab
Ab interno failure Increased IOP _ Appositional contact between the iris and trabecular meshwork _ Peripheral anterior synechia _ TDM fibrosis _ Iris incarceration _ Goniopuncture _ Iridoplasty _ Reopening primary surgical site _ Another surgery
Iridoplasty _ Spot 500 µ _ 150-200 ms _ 150-300 mW
Goniopuncture _ Notbefore 2 weeks _ NdYag: 2-4 mJ _ Avoidhigh IOP _ TDM transparency _ Pilocarpine _ Iridoplasty Dr. M Javier González,Vigo
Goniopuncture _ V-2000 _ V-Clip Always consider Iridoplasty !!!
Iridoplasty & Goniopuncture 1_ Pilocarpine 2_ Argon Laser 3_ NdYAG
Iridoplasty & Goniopuncture Nitin Anand MD Ophthalmologist Winfield Hospital,UK
Iridoplasty & Goniopuncture Synechia 1_ Pilocarpine 2_ Argon Laser 3_ NdYAG Incarceration
Surgicalarea: AS-OCT _ Intrascleral bleeding _ Intrascleral bridges
Surgicalarea: AS-OCT _ uveal prolapse
Surgicalarea: AS-OCT Transparent TDM Reopening primary surgical site Same Site Technique Another surgery
Moltes gràcies http://drloscosoftalmologia.com/