CataractCoach™ 2270: angle closure glaucoma with corneal edema
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- Опубліковано 10 вер 2024
- This patient has experienced angle closure glaucoma which has caused corneal edema and an increased intra-ocular pressure (IOP). In the clinic you are unable to perform a successful laser peripheral laser iridotomy so you elect to perform cataract surgery instead. You learn from the CataractCoach Podcast with Johnny Gayton MD that the best treatment may actually be performing cataract surgery for this patient. The interesting part of this video is how the cornea starts out edematous and cloudy but by the end of the case, it is normal thickness and non-edematous. Great learning case.
Good learnings. I would prefer to use IV mannitol to reduce the IOP, clear the corneal edema and the lens iris diaphragm would also fall back and shrink the vitreous body with much less incidence of PCR and impending vitreous loss. Cataract surgery in itself is a procedure to control IOP in ACG but if PAS has formed and is more than 270 degrees, you would need to do a glaucoma procedure- for me is the time tested trabeculectomy.
Micro invasive glaucoma surgery is effective in the situation you describe. Visco-dissect the PAS off first. I have also used clear lensectomy, viscodissection and iStent implants successfully to address "creeping angle closure" glaucoma.
The Eagle trial showed that Clear Lens Extraction (CLE) is more cost effective and efficacious than conventional tratment. So accordingly not only in cataractous eyes with acute angle closure, a "HOT PHACO" can be performed even in the absence of cataract in an eye with angle closure.
Very informative video. A tad different opinion though..
If we manage to get PI done in a very shallow Ac it deepens the AC and makes life easier during cataract surgery.
Better to give than receive! Love it!
Great job!!!!
No drape, meibomian secretions pooling in the tear film...
I don't want to be mediocre! 😅