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Medical treatment of open-angle glaucoma

International Centre for Eye Health
Publication Date
  • Medical Treatment
  • Instructions For Patients
  • Medicine


CEHJ79_FINAL4_OA.indd Community EyE HEaltH Journal | VolumE 25 iSSuES 79 & 80 | 2012 77 needling is haemorrhage – either sub-conjunctivally or into the anterior chamber. If your view is obscured, then you should stop and try another time. A hyphaema requires the patient to be reassured, as their vision will be affected: you should wait until you are sure the active bleeding has stopped. Let the patient rest for 30–60 minutes then check for ongoing haemorrhage and a pressure rise, since the blood can sometime obstruct drainage completely. Once stable, manage the patient as for a hyphaema post-trabeculectomy: discharge the patient and review within one week as appropriate. The other post-needling complication is hypotony. I personally have only had to take one patient back to theatre for this to date. If the anterior chamber has signifi - cantly shallowed, let the patient rest and see if it reforms spontaneously. If it does, then manage the patient as for a low pressure following trabeculectomy. If it does not, then introducing viscoelastic or gas to the anterior chamber is your best option, with regular review as appropriate. Case reports exist of infection and mis-placed needles, but these are fortu- nately rare (hopefully because appropriate care has been taken by clinicians). Prophylactic topical antibiotics are used by most practitioners. Pre- and post- operative steroids remain a mainstay of therapy to prevent recurrent scarring. Sub-conjunctival steroid and 5-fl uor- ouracil (5FU) are the most common antiscarring preparations. Be extremely careful that the drugs do not enter the anterior chamber. If they do, wash out in theatre immediately. See page 75 for tips on administration of 5FU. Mitomycin C is being used more frequently, and interferon, sodium hyaluronate, and bevacizumab are amongst the many additional agents that have been reported, with varying success. If needling is not appropriate or has failed, what subsequent procedure

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