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Personalized Glaucoma Follow Up with AS-OCT after Deep Sclerectomy: Luxury but Necessity

This article explores the necessity and benefits of using AS-OCT for personalized glaucoma follow-up after deep sclerectomy surgery. It discusses the ideal bleb, intrascleral bleb changes, implant placement/displacement, and assessment before reoperation.

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Personalized Glaucoma Follow Up with AS-OCT after Deep Sclerectomy: Luxury but Necessity

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  1. Personalized Glaucoma Follow Up with AS-OCT after Deep Sclerectomy:Luxury but Necessity Jordi Loscos Arenas MD, PhD Hospital Universitari Germans Trias i Pujol, Barcelona

  2. Financial disclosure Grants / Research supports _ Santen Pharmaceutical _ Aeon astron _ Allergan _ AJL Opthalmics

  3. Personalized Glaucoma Follow Up with AS-OCT after Deep Sclerectomy: Luxury but Necessity

  4. Necessity Luxury

  5. Personalized Glaucoma Follow Up with AS-OCT after Deep Sclerectomy: Luxury but Necessity

  6. Personalized Glaucoma Follow Up with AS-OCT after Deep Sclerectomy: Luxury but Necessity _ Is there an ideal bleb? _ Intrascleral bleb changes _ Implant placement /displacement _ Assessment Pre/Post Needling _ Assessment Pre/Post Goniopuncture _ Assessment before reoperation

  7. Is there an ideal bleb? _ Transcleral outflow _ High intrascleral bleb

  8. Is there an ideal bleb? Br J Ophthalmol 2010;94:410e413 ? IOP - height positive correlation, IOP – height inverse correlation

  9. Is there an ideal bleb? _ Supraciliar implantation _ No suture _ Intrascleral implantation _ Scleral flap sutured _ Transcleral outflow _ High intrascleral bleb _ Uveoescleral outflow

  10. Morphological intrascleral bleb changes IOP 12 No treatment IOP 16 No treatment 24-4-2012 22-4-2013 IOP 20 Goniopuncture IOP 18 Latanoprost 26-1-2016 24-3-2014

  11. Morphological intrascleral bleb changes _ Blood over TDM _ Intrascleral bridges _ Intrascleral bleeding

  12. Implant localization _Suprachoroidall ˃2.5 mm _Supraciliary <1.5-2mm _ Implant over TDM

  13. Cyclodialysis _ Cyclodialysis does not exist with high funcional conjunctival blebs _ High functional conjunctival blebs do not exist with cyclodialysis _ Uveoscleral outflow can exist in both situations 15-5-2013 3-10-2013 2-4-2018

  14. Implant localization 6-5-2013 4-9-2012 5-5-2014 12-9-2016 2-5-2017 26-5-2015 _ Anterior implant displacement _ Posterior implant displacement

  15. Assessment Pre/Post Needling _ Ciliary body prolapse

  16. Assessment Pre/Post Needling Pre Pre Post Post

  17. Assessment Pre/Post Goniopuncture

  18. Assessment Pre/Post Goniopuncture

  19. Assessment Pre/Post Goniopuncture Pre Post

  20. Assessment before Reoperation Same Site reoperation Transparent TDM Two Site reoperation No transparent TDM

  21. Take Home Message • _ AS-OCT provides personalized DS follow up • _ One step ahead IOP increase • _ Improve our results • _ Avoid and manage complications • _ Feedback

  22. Take Home Message Luxury Dependences Necessity Always CLINICAL approach

  23. Moltes gràcies http://drloscosoftalmologia.com/

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