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A quadruple approach for the treatment of persistent silicone oil induced glaucoma

Session Details

Session Title: Vascular Diseases & Anterior/posterior segment surgery

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 12:36

Venue: Hall 3 (Level 0)

First Author: A.Saeed EGYPT

Co Author(s):                  

Abstract Details

Purpose:

To provide a solution to persistent silicone oil induced glaucoma (SOIG), which represents a common type of intractable glaucoma that usually adds to the hazards of complicated vitreoretinal surgeries. The trial aimed to evaluate the efficacy and safety of a quadruple approach which consists of Trabeculectomy with intraoperative mitomycin-c (MMC) application, bevacizumab injection, postoperative topical MMC drops and Trans-scleral diode cyclophotocoagulation (TSDCP) was applied late when indicated.

Setting:

Ophthalmology Department at Benha University, and Ebsar eye center, Benha, Egypt.

Methods:

17 eyes of 17 patients presented with SOIG were included in this controlled non- randomized prospective clinical trial. All eyes underwent trabeculectomy with intraoperative mitomycin-c (MMC) application plus subconjunctival bevacizumab injection (1.25mg) together with early postoperative topical MMC drops (0.03mg/ml) 4 times daily for at least 10 days. Trans-scleral diode cyclophotocoagulation (TSDCP) was applied late when there is insufficient IOP control. The main outcome results included cumulative probability of surgical success, IOP values, number of antiglaucoma drugs needed, and BCVA.

Results:

The (Quadruple Approach) achieved a cumulative probability of success of 0.765 at the end of the 24months study period and was in a range of 0.883 at 2w and 0.647 at 6m. Complete success was achieved in a range of 82.4% at 2w and 35.3% at 18 and 24m. There were always highly statistically significant decreases in the mean IOP values and numbers of the given IOP lowering drugs at all postoperative time points (p was always <0.001). The duration of SO tamponade had an adverse impact on IOP and BCVA both at the baseline and at 24 months. TSDCP was applied upon 47% patients with a success rate of 81.8%. All complications were controlled with no major drawbacks. No significant adverse effects were caused by this combined approach.

Conclusions:

The (Quadruple Approach) could present an efficient, safe, familiar and applicable treatment strategy for the treatment of persistent SOIG. It may provide a favorable long-term outcome, representing an acceptable encouraging simple solution to the problem of persistent SOIG, which represents a common type of refractory glaucoma.

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