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Glaucoma Surgery Flashcards

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1
Q

Spaeth classification of shallow AC post TRAB

A

1 peripheral ICT
2 + central ICT
3 + IL C touch in pupillary area

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2
Q

Post Trab

High IOP
Shallow AC centrally and peripherally
Dx?

A

Malignant glaucoma
Supra choroidal hmg

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3
Q

Post Trab

High IOP
Shallow AC peripherally, formed centrally
Dx?

A

Pupillary block

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4
Q

Treatment of Malignant glaucoma

A

Cycloplegic Atropine
Aqueous suppressants Timolol: Avva
Mannitol
Laser Hyaloidotomy NdYAG
PPV

Through PI Iridectomy, Zonulectomy, Vitrectomy

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5
Q

Treatment of Pupillary block

A

LI

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6
Q

Treatment of Supra choroidal hmg

A

Initial/Medical
Wound closure, atropine, steroids (topical/systemic), IOP-lowering drugs

Observation
For small, non-appositional SCH – monitor with B-scan

Surgical
Drainage after 7–14 days if large or appositional SCH

Emergency surgery
If severe pain or IOP uncontrolled despite medical therapy

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7
Q

Post Trab

High IOP
Deep AC
Dx?

A

Filtration failure

Blocked sclerostomy
Tight sutures/ Scarring/

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8
Q

Low IOP
Shallow AC
In TRAB
Diagnosis?

A

Wound leak
Over filtration
Choroidal effusion

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9
Q

Low IOP
Deep AC

A
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10
Q

Ideal patient for TRAB

A

40 yrs older and more
Phakic
Non inflamed
No HO of surgery

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11
Q

Trab failure risk factors

A

Young
HO Previous surgery
HO previously failed GFS
Scarred conjunctiva
IO inflammation

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12
Q

Indications of TRAB

A

Uncontrolled IOP even on Max Medical Rx
Advanced DISC/Field changes with IOP fluctuations
MEDs related
1. Intolerance or allergy to meds
2. Non compliance
3. Afford
4. QOL, free from Eyedrops

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13
Q

Goal of TRAB

A

Preserve useful Vn
Avoid further damage
Enhance QOL

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14
Q

Need for Urgent TRAB

A

Rapid deterioration of VFD or ONH appearance
Adv stage of ONH or VFL
IOP to a level considered to cause Rapid worsening of ONH/ VF

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15
Q

Goal of Trab

A

Preserve, not improve Vn

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16
Q

Preop evaluation in TRAB

A

Systemic disease (DM)
Anticoagulant
Chronic cough, constipation

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17
Q

Preop meds alteration in Trab

A

Antibiotic
Preop steroid if Uveitic glaucoma
Aspirin stop 4 weeks started 2 weeks post op
Stop Pilo 6 days and Brimonidine 2 days before
Mannitol before Sx

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18
Q

Preferred site for TRAB and why

A

12 o clock
Easy access
Bleb covered
No Diplopia

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19
Q

Trab endoph at which site

A

Inferior

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20
Q

Which Flap is better in TRAB

A

No influence on ultimate success of flap

Limbal: more localized & elevated
Fornix: more diffuse & flattened

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21
Q

Advantages of Limbal based flap on Trab

A

Tenectomy easy
Massage is safe

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22
Q

DisAdvantages of Limbal based flap on Trab

A

Button hole
Less surgical exposure

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23
Q

Advantages of Fornix based flap on Trab

A

Easy
Good surgical exposure
Less button holing

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24
Q

DisAdvantages of Formix based flap on Trab

A

Tenectomy difficult
Aqueous leak at limbus
Caution at Massage

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25
Paracentesis done prior to Where
AC entry 10 or 2 o clock
26
Paracentesis of Trab useful for
Stepwise IOP lowering End of surgery for Bleb forming and deepening AC
27
Thickness of Scleral flap of TRAB
1/3 to 1/2
28
Sclerostomy size of TRAB
3 * 1 mm block
29
Why iridectomy in TRAB
To prevent Iris incarceration To prevent PB Should be wider than sclerectomy
30
Conj flap closure technique
8 0 vicryl round body Running mattress for water tight closure Knots tied at both ends
31
MMC in Trab conc
0.02%
32
FFU conc in Trab
50 mg/mL
33
Side effect of MMU in Trab
Cystic Bleb Bleb leak Sckeral thinning Ciliary body ischemia
34
Side effect of FFU in Trab
Corneal toxic
35
What type of device is AADI?
Non-valved glaucoma drainage device (modeled on Baerveldt)
36
What type of device is AGV?
Valved glaucoma drainage device
37
What is the plate material of AADI?
Medical-grade silicone
38
What is the plate material of AGV?
Polypropylene (older models) or silicone (newer FP series)
39
Does AADI have a valve mechanism?
No, requires tube ligature/occlusion to prevent hypotony
40
Does AGV have a valve mechanism?
Yes, venturi-type valve made of silicone elastomer membranes
41
What is the plate surface area of AADI?
~350 mm² (large)
42
What is the plate surface area of AGV?
~184 mm² (smaller)
43
What is the onset of action of AADI?
Delayed (4–6 weeks, after capsule forms and ligature dissolves)
44
What is the onset of action of AGV?
Immediate (valve works from day 1)
45
What is the principle of functioning of AADI?
Aqueous outflow only after fibrous capsule matures
46
What is the principle of functioning of AGV?
Valve opens at ~8–12 mmHg, closes at <8 mmHg, prevents hypotony
47
What is the cost comparison of AADI?
Low-cost, Indian-made, economical
48
What is the cost comparison of AGV?
Expensive, imported device
49
What are the advantages of AADI?
Large surface area, greater long-term IOP reduction, affordable, useful in developing countries
50
What are the advantages of AGV?
Immediate IOP control, lower risk of early hypotony, simpler postoperative management
51
What are the disadvantages of AADI?
Risk of early hypotony if ligature fails, delayed IOP control, more intensive postop care
52
What are the disadvantages of AGV?
Smaller surface area with higher chance of long-term failure, costly, risk of valve-related encapsulation (hypertensive phase)
53
What was the purpose of the Ahmed–Baerveldt Comparison (ABC) Study?
To compare safety and efficacy of Ahmed Glaucoma Valve (AGV) vs Baerveldt Glaucoma Implant (BGI) in refractory glaucoma.
54
What type of study was the ABC study?
Multicenter, randomized controlled trial.
55
What was the plate size of AGV used in the ABC study?
184 mm².
56
What was the plate size of BGI used in the ABC study?
350 mm².
57
Which device achieved greater long-term IOP reduction in the ABC study?
Baerveldt Glaucoma Implant (BGI).
58
ABC STUDY; Which device had lower mean IOP in long-term follow-up?
Baerveldt Glaucoma Implant (BGI).
59
Which device had fewer cases of early postoperative hypotony?
Ahmed Glaucoma Valve (AGV).
60
Which device showed a higher long-term success rate?
Baerveldt Glaucoma Implant (BGI).
61
Which device required more reoperations in the ABC study?
Ahmed Glaucoma Valve (AGV).
62
Which device had fewer severe complications?
Ahmed Glaucoma Valve (AGV).
63
Which device was associated with more severe complications such as hypotony-related issues and corneal problems?
Baerveldt Glaucoma Implant (BGI).
64
What was the risk of vision loss in AGV vs BGI according to the ABC study?
Slightly lower with AGV, slightly higher with BGI.
65
What is the key conclusion of the ABC study?
AGV is safer in early postoperative period but less effective long-term; BGI is more effective in long-term IOP control but riskier.
66
What is the exam memory aid for the ABC study findings?
Ahmed = Safety, Baerveldt = Efficacy.
67
What is the main pressure-related complication after GDD surgery?
- Hypotony (IOP persistently below normal)\n- Most significant pressure issue after GDD
68
What are the causes of hypotony after GDD?
- Leakage from surgical site\n- Inadequate capsule formation\n- Excessive aqueous outflow\n- Non-device related: choroidal detachment, ciliochoroidal effusion
69
How can hypotony after GDD be prevented?
- Use of valved implants\n- Tube stenting or ligation\n- Proper surgical technique
70
How is hypotony managed when the anterior chamber is normal?
- Observation only
71
How is hypotony managed when there is a wound leak?
- Repair wound (scleral patch, amniotic membrane)
72
How is hypotony managed when the anterior chamber is flat?
- Reformation with viscoelastic\n- Use of long-acting gas
73
How is hypotonic maculopathy managed?
- Scleral patch graft\n- Surgical intervention if persistent
74
What is an early postoperative complication related to GDD?
- Shallow or flat anterior chamber
75
What are the causes of a shallow anterior chamber after GDD?
- Overfiltration (excess aqueous drainage)\n- Wound leak\n- Ciliary body shutdown
76
How is shallow anterior chamber managed in GDD patients?
- Conservative: cycloplegics, pressure patch, bandage CL\n- Surgical: viscoelastic/gas injection, wound repair
77
What late complication may occur due to GDD overfiltration?
- Hypotony maculopathy\n- Chronic choroidal detachment
78
What device-related complications can occur after GDD?
- Tube malposition (touching cornea, iris, lens)\n- Tube blockage (blood, fibrin, vitreous)\n- Plate exposure or erosion
79
How is tube malposition managed in GDD?
- Tube trimming\n- Repositioning with scleral fixation or graft
80
How is tube blockage managed in GDD?
- Nd:YAG laser to clear obstruction\n- Surgical revision if persistent
81
How is plate exposure or erosion managed in GDD?
- Cover with donor sclera, pericardium, or corneal patch graft\n- Surgical revision if needed
82
What are hypertensive phase features after GDD?
- Rise in IOP within 1–3 months postop\n- Due to encapsulated bleb around plate
83
How is hypertensive phase managed after GDD?
- Topical anti-glaucoma medications\n- Bleb massage\n- Needling or revision if persistent
84
What are the late complications of GDD surgery?
- Diplopia due to motility restriction\n- Endophthalmitis\n- Corneal decompensation\n- Failure of bleb function
85
How is diplopia from GDD managed?
- Prism glasses\n- Strabismus surgery if persistent
86
How is corneal decompensation managed in GDD patients?
- Bandage contact lens\n- DSEK or PK in advanced cases
87
What factors influence GDD surgical success?
- Type of implant (valved vs non-valved)\n- Surgeon’s technique\n- Patient’s healing response\n- Adequate postoperative management
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