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Numerous factors affect surgical decisions in glaucoma patients
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 Sanjay Asrani |
VIENNA, Austria — Deciding to perform surgery on a glaucoma patient and then choosing the best surgical option are processes with many issues to consider, a physician said here.
"To operate or not to operate is the first question we all have to answer," Sanjay Asrani, MD, said. "Sometimes the best option is don't just do anything — stand there."
Dr. Asrani shared pearls from 18 years as a glaucoma specialist at Glaucoma Day preceding the European Society of Cataract and Refractive Surgeons meeting. He said physicians should weigh a range of considerations and questions before deciding to perform glaucoma surgery.
"In patients with silicone oil ... with aphakia, about age 90, consider transscleral cyclophotocoagulation rather than penetrating surgery," he said. "Has real progression been confirmed, or is it just visual field fluctuation? Have you tried all practical nonsurgical options, like SLT? Does the patient think that the surgery is going to be a cure?"
He outlined preoperative issues in surgery, including trabeculectomy, tube shunt surgery and cataract surgery, as well as surgical modification.
For instance, a preoperative consideration before trabeculectomy is patient hygiene, which could affect infection rate after surgery. Dr. Asrani recommended that physicians observe patients' nails and hair care to get an idea of their hygiene.
- Disclosure: Dr. Asrani has no relevant financial disclosures.
Dr. Asrani pointed out the need for considering several issues when offering glaucoma surgery. In fact, traditional filtering glaucoma surgery is far from being perfect and might end in some vision-threatening complications. Besides, the presence of a conjunctival filtering bleb (anywhere it is and however it looks) exposes the eye to lifelong problems, like infections, aqueous leak, etc. Therefore, when considering filtering surgery, one should have an unquestionable “clinical evidence” of disease progression. Again, once surgery has been done, patients should be carefully watched according to the individual risk for long-term bleb-related complications, with particular care given to situations leading to ocular surface problems.
– Stefano Gandolfi, MD
OSN Europe Edition
Editorial Board Member
Disclosure: Dr. Gandolfi has no relevant financial
disclosures.