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PubMed · 1297508

Indications for trabeculectomy in open angle glaucoma.

H Cohn
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Abstract

Trabeculectomy is the most commonly performed filtering procedure in the surgical treatment of open angle glaucoma. One may oversimplify and state that a trabeculectomy is indicated in a case of uncontrolled IOP on maximum tolerated medical therapy in the presence of significant optic disk and/or visual field changes. However, before one actually proposes a trabeculectomy one must consider for a given patient: How does one define IOP control? What are the chances of success of the surgery? What are the operative risks? What are the risks of not operating for the case under consideration? And more generally: What are the arguments of earlier surgery? Where does Argon Laser Trabeculoplasty fit into the therapeutic regimen? The questions are examined with the specific goal of making a rational decision for the patient at hand.

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Glaucoma, Open-AngleHumansLaser TherapyRisk FactorsTrabeculectomyJournal Article

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H Cohn. 1992. Indications for trabeculectomy in open angle glaucoma.. https://pubmed.ncbi.nlm.nih.gov/1297508/

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PubMed2006

Screening for prevention of optic nerve damage due to chronic open angle glaucoma.

BACKGROUND: Open angle glaucoma (OAG) is a primary, progressive optic neuropathy; the onset is without symptoms and progression occurs silently until the advanced stages of the disease, when it affects central vision. The blindness caused by OAG is irreversible. It has often been assumed to be a condition that fulfils the criteria for population screening, although this has not been supported by other in-depth non-systematic reviews. The focus of this review was to examine the evidence for the effectiveness of screening for OAG. OBJECTIVES: To determine the impact of screening for OAG compared with opportunistic case findings or current referral practices on the prevalence of and the degree of optic nerve damage due to OAG in screened and unscreened populations. SEARCH STRATEGY: We included any randomised controlled trial (RCT) evaluating population-based screening programmes for OAG with a minimum one year follow up. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (which contains the Cochrane Eyes and Vision Trials Register) (Issue 1, 2006), MEDLINE (1950 to February 2006) and EMBASE (1988 to February 2006). We also searched the National Research Register (Issue 1, 2006) and Zetoc for grey literature (29 June 2006). There were no language or date restrictions in the electronic searches. SELECTION CRITERIA: We planned to include RCTs, including cluster RCTs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the study abstracts identified by the electronic searches. We did not find any trials that met the inclusion criteria. MAIN RESULTS: As no trials were identified, no formal analysis was performed. AUTHORS' CONCLUSIONS: On the basis of current evidence, population-based screening for chronic OAG cannot be recommended, although much can be done to improve awareness and encourage at risk individuals to seek testing. In wealthy countries with equitable access to high quality eye care and health education, blindness from chronic OAG should become increasingly rare; much greater challenges face poor and emerging economies and countries where there are substantial health and wealth inequalities. Effectiveness of screening for OAG can be established only by high quality RCTs.

Glaucoma, Open-Angle↗
PubMed2006

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