Novetly and disagreements in the treatment of glaucoma

Novetly and disagreements in the treatment of glaucoma

At the IMO Congress on Trends in the Treatment of Glaucoma, a new perspective was presented on the use of various techniques for an individual approach to the treatment of the disease.

More than 250 ophthalmologists gathered at the Institute on November 14 and 15 to attend the “Trends in the Treatment of Glaucoma” congress, the international congress on pathologies organized by the Foundation. Under the leadership of Dr. Elena Arrondo, Dr. Silvia Freixes and Dr. Carolina M. Palyas, the meeting emphasized the importance of an individual approach in the treatment of glaucoma, discussed alternative and new therapeutic methods of treatment, with particular attention paid to surgical operations.

One of the main tasks in modern surgical treatment of the Gluacoma is to avoid scars, which in one way or another can be the result of an operation, no matter how well it is performed, and which are so difficult to avoid. According to Dr. Gonzalo Muñoz , one of the speakers of the congress, “we must fight for the opening of new directions in order to facilitate the outflow of aqueous humor. “Another speaker, Dr. Elena Milya, recommended that “it is necessary to ensure that the eye is as prepared for the operation as possible, to use the most accurate technique and various methods known to date, to avoid the appearance of scars, and also to pay special attention during the postoperative period”.

A specialist in the pathology of glaucoma must take into account that surgery, whether it is a trabculectomy or deep sclerectomy, may, over time, become ineffective in solving this problem. Therefore, in half of the cases, reoperation or supportive treatment through drugs in the postoperative period or through certain postoperative procedures is required. According to the speakers, drainage shunts are one of the main techniques in cases where large scars remain (eyes that have undergone multiple operations, perennial treatment with eye drops, etc.), since “they are considered the most predictable, though minimally invasive,” according to Dr. Suzanne Bowers.

The study of minimally invasive procedures for the patient is another important task in the resolution of glaucoma, to which laser treatment methods are also oriented. While argon remains the most common substance and is used in almost any examination by an ophthalmologist, being the most cost-effective, it can also be used to treat other diseases, such as selective laser trabeculoplasty, where it begins to be widely used.

The technique known under the English abbreviation SLT (SLT) “achieves the same hypotensive effect as after the application of an argon laser, without causing structural changes in the trabecular network, and is equally safe and easy to use,” explains Dr. Alfonso Anton at the congress “Trends in treatment of glaucoma “. These benefits also apply to Laser Pascal (PLT), the latest development for trabeculoplasty, which reduces risks and reduces the likelihood of future complications, which can also be used in retinal treatment.

According to Dr. Anthony Dow, “Pascal laser functions well and shows effective reduction in intraocular pressure, although there is currently not much research to confirm this fact.” In any case, and with reference to the American Academy of Ophthalmology (AAO), the ophthalmologist came to the conclusion that “to date, there has been no clinical superiority in the use of any particular type of laser used intrabeculoplasty .”

The choice of the most appropriate treatment will depend on the attending ophthalmologist only, his own discretion and experience, and the specific characteristics of each patient, taking into account the risk factors, type and stage of development of glaucoma. Adhering to an individual approach to pathology, the congress, held at IMO last November, discussed various cases that experts face in their practice.

In this regard, a separate session of the congress was devoted to angle-closure glaucoma, which occurs when the angle between the cornea and the iris is too narrow, so cataract surgery is appointed, “which allows you to win space when replacing the eye lens with an intraocular lens,” explained Dr. Silvia Freixes, ophthalmologist IMO and co-director of the congress.

At the congress, they also talked about neovascular glaucoma, when intraocular pressure is normal and it has not yet been proved whether pressure reduction by 30% will help prevent exacerbation of the disease, as well as secondary glaucoma associated with other diseases, such as diabetic retinopathy or the postoperative effect, example, after surgery for detached retina or cornea. In such cases, ascommented Dr. Elena Arrondo, Co measures and a specialist in glaucoma of the Institute, “the probability of developing the disease increases and subsequent treatment, as a rule, becomes more difficult, because the drugs often do not give the desired result, and traditional surgical operations are often ineffective.”

Another type of patients on which the attention of specialists is focused is pediatric patients due to the difficulty of surgical operations for glaucoma in children with myopia (especially patients with more than 6 diopters). This is a special category of patients with a triple risk factor for developing the disease.

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