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PubMed · 7798729

Overview and new technology in cyclodestructive procedures.

J Fishbaugh
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Abstract

When all medical and surgical measures have failed to lower intraocular pressure (IOP) in patients with severe and uncontrolled glaucoma, ophthalmologists must turn to cyclodestructive procedures to decrease aqueous production. Several months ago, the FDA (Food and Drug Administration) came through with an approval for a new technology in cyclophotocoagulation therapy. The IRIS Medical G-Probe used in conjunction with a semiconductor diode laser may be the superior alternative to previously available cyclodestructive techniques for which ophthalmologists have been searching.

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GlaucomaHumansLaser CoagulationLight CoagulationUnited StatesUnited States Food and Drug AdministrationJournal ArticleReview

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J Fishbaugh. 1994. Overview and new technology in cyclodestructive procedures.. https://pubmed.ncbi.nlm.nih.gov/7798729/

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PubMed2006

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

AIM: To compare the effect on intraocular pressure (IOP) of large vs small scleral flap size during trabeculectomy using adjustable sutures. METHODS: Trabeculectomy operations were performed on nine donor human eyes connected to a constant flow infusion with real-time IOP monitoring. Large scleral flaps (4 x 4 mm, 16 mm(2), n=12) or small scleral flaps (3 x 2 mm, 6 mm(2), n=9) were constructed over 0.76 mm(2) sclerostomies. For each procedure, equilibrium IOP was measured following tight closure with two four-throw adjustable 10-0 nylon sutures. RESULTS: Five scleral flaps were thin or poorly constructed; four of these were in the initial seven procedures, implying learning effect. These had a mean absolute IOP of 7.6 mmHg (range 2.7-12.4 mmHg) and mean relative IOP of 28.3% of baseline (range 10-45.8%) after closure. In the remaining 16 good quality procedures, mean IOP was 1.3 mmHg (range 0-3.4 mmHg) after sclerostomy, confirming minimal outflow resistance before closure. Following flap closure mean IOP was 20 mmHg (SD 4.4, range 15.5-29.3 mmHg) for large (n=8), and 18.7 mmHg (SD 3.6, 15.9-25.8 mmHg) for small (n=8) flaps (unpaired t-test, P=0.26). Mean IOP (% baseline) was 71.6% (SD 8.4, range 60.6-86.6%) and 66% (SD=12.7, 46.8-86.6%) for large and small flap groups, respectively (unpaired t-test, P=0.2). CONCLUSIONS: Well-constructed scleral flaps of both sizes were able to support an average IOP at least two-thirds of baseline, and both had similar absolute IOP levels. Errors in flap construction resulted in loss of IOP control. Smaller flap size does not appear to compromise control of early postoperative IOP using adjustable sutures.

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