Chỉ dẫn Nguyên tắc chung: chỉ trabeculectomy (Khi IOP được nâng lên một mức độ mà có bằng chứng về tiến bộ VF hoặc VỀ thay đổi mặc dù điều trị y tế tối đa) cộng với chỉ định phẫu thuật đục thủy tinh thể (suy giảm thị giác) | 26 The Ophthalmology Examinations Review Concomitant risk factors for glaucoma DM HPT myopia other vascular diseases Compliance to follow-up and medication use What are the indications for a combined cataract extraction and trabeculectomy In general this procedure is indicated when there is a SIMULTANEOUS need for trabeculectomy and cataract operation. ữExam tips Essentially identical to the indications for trabeculectomy page 80 Combined cataract extraction and trabeculectomy NOTES What are common scenarios for trabeculectomy Uncontrolled POAG with maximal medical treatment Failure of medical treatment IOP not controlled with progressive VF or ON damage Side effects of medical treatment Noncompliance with medical treatment Additional considerations Young patient with good quality of vision One-eyed patient other eye blinded from glaucoma Family history of blindness from glaucoma Glaucoma risk factors HPT DM Uncontrolled PACG after laser PI and medical treatment Secondary OAG or ACG 1. Indications General principle indications for trabeculectomy When IOP is raised to a level that there is evidence of progressive VF or ON changes despite maximal medical treatment plus indication for cataract surgery visual impairment 2. Advantages One operation Faster visual rehabilitation Patient may be taken off all glaucoma medications No subsequent cataract operation needed lower risk of bleb failure 3. Disadvantages More manipulation during the combined operation higher risk of bleb failure Vitreous loss during cataract surgery higher risk of bleb failure Larger wounds created higher risk of wound leakage and shallow AC 4. Alternative ways to perform the combined operation Corneal section ECCE plus trabeculectomy Advantages More control Less conjunctival manipulation Smaller wound lower risk of leakage and shallow AC Disadvantages Longer Greater corneal astigmatism Limbal section ECCE plus trabeculectomy Advantages Faster Less astigmatism Disadvantages Larger wound More .
