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Angle Closure and Angle Closure Glaucoma (part 5)

Chúng bao gồm lọc phẫu thuật một mình, một mình khai thác ống kính, ống kính kết hợp khai thác và lọc phẫu thuật, thủ tục mở rộng góc như goniosynechialysis, một thủ tục và mở rộng góc kết hợp với ống kính khai thác. Cân nhắc khác bao gồm các phương pháp khai thác ống kính | 30 T. Aung P. RojanaPongpun J. Salmon the surgical options for PACG are diverse. These include filtering surgery alone lens extraction alone combined lens extraction and filtering surgery angle widening procedures such as goniosynechialysis and an angle widening procedure combined with lens extraction. Other considerations include the method of lens extraction be it phacoemulsification or ECCE the use of antimetabolites and the number and choice of surgical sites in filtering surgery. Randomized controlled trials are necessary to evaluate these types of surgery in PACG. Trabeculectomy The indications for trabeculectomy in PACG are the same as in POAG. These include inadequate control of IOP despite LPI continuing optic disc visual field damage and intolerance to medical therapy. The indications for the use of anti-scarring agents are also similar to that of POAG namely eyes at high risk of failure of surgery such as those with previous failed trabeculectomy those with advanced disease extensive PAS optic nerve damage and visual field loss and those on multiple medications. In many centers anti-scarring agents are used routinely for all trabeculectomies. There have been no randomized controlled trials published to date for trabeculectomy in PACG. A retrospective study from India showed that trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of ten years in patients with PACG with similar outcomes as POAG. About a third of PACG cases had a two-line decrease in visual acuity due to the development of a cataract.26 In eyes with PACG malignant glaucoma is commonly cited as a possible complication following trabeculectomy. However this was not observed in a study by Watson et al. conducted in the UK which showed similar complication rates to POAG and angle closure eyes.27 Lens extraction alone It is believed that the size and position of the lens plays a major role in the pathogenesis of .