Speaker reviews surgical treatment protocols for angle-closure glaucoma

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At OSN New York 2012, Garry P. Condon, MD, presented surgical pearls and an overview of literature on evolving treatment protocols for cataract removal in cases of angle-closure glaucoma."/><meta id="metaKeywords" name="keywords" content="Ocular Surgery News,Ophthalmology,Glaucoma,Cataract Surgery,Meeting News Coverage"/><meta id="Meta1" name="scID"/><meta id="scID" name="scID"/><meta name="PostedDate" content="2012-11-20"/> <meta name="specialties" content="Ophthalmology"/> <meta name="specialty" content="Ophthalmology"/> <meta name="primary_specialty" content="Ophthalmology"/> <meta name="subspecialties" content="Glaucoma,Cataract Surgery"/> <meta name="subspecialty" content="Glaucoma"/> <meta name="subspecialty" content="Cataract Surgery"/> <meta name="primary_subspecialty" content="Glaucoma"/> <meta name="departments" content="Meeting News Coverage"/> <meta name="department" content="Meeting News Coverage"/> <meta name="content_type" content="News Article"/> <meta name="pageid" 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href="https://web.archive.org/web/20130903024442/http://www.healio.com/ophthalmology/glaucoma/news/online/%7Ba65d3d85-a747-4b65-93f2-d113a2376e3b%7D/open-angle-glaucoma-patients-not-receiving-recommended-visual-field-tests">Open-angle glaucoma patients not receiving recommended ...</a></li><li><a href="https://web.archive.org/web/20130903024442/http://www.healio.com/ophthalmology/glaucoma/news/online/%7B2acc03cc-280d-41a1-97f1-55f2d8920ac4%7D/malignant-glaucoma-responds-well-to-treatment-algorithm">Malignant glaucoma responds well to treatment algorithm ...</a></li><li><a href="https://web.archive.org/web/20130903024442/http://www.healio.com/ophthalmology/glaucoma/news/online/%7B71f7ad52-256e-4892-9374-e75e91144ffa%7D/glaucoma-implant-with-scleral-buckling-effective-for-glaucoma-retinal-detachment">Glaucoma implant with scleral buckling effective for glaucoma ...</a></li></ul></div>  <div class="content"> <h2> Speaker reviews surgical treatment protocols for angle-closure glaucoma</h2> <h3 class="deck"> </h3> <p class="main-subtitle"> </p> <div class="social-links-top"> <ul class="share"> <li class="l1"><a href="javascript:void(0)" class="facebook-link" target="_new">Facebook</a></li> <li class="l2"><a href="javascript:void(0)" class="twitter-link" target="_new">Tweet</a></li> <li class="l3"><a href="javascript:void(0)" class="linkedin-link">Share</a></li> </ul> </div> <ul class="meta-info"> <li> Ocular Surgery News U.S. Edition, January 10, 2013</li> </ul> <div class="wyContent"> <p style="margin: 0in 0in 10pt;">NEW YORK — Phacoemulsification with IOL implantation is a viable approach in cases of acute angle-closure <a href="https://web.archive.org/web/20130903024442/http://www.healio.com/ophthalmology/glaucoma" target="_blank">glaucoma</a>, a speaker said here.</p> <p style="margin: 0in 0in 10pt;">At <a href="https://web.archive.org/web/20130903024442/http://www.healio.com/ophthalmology/meetings/meeting-news-coverage?setid={A674D394-E846-4A5D-916D-E0EA07FE3209}" target="_blank">OSN New York 2012</a>, <b>Garry P. Condon, MD,</b> presented surgical pearls and an overview of literature on evolving treatment protocols for <a href="https://web.archive.org/web/20130903024442/http://www.healio.com/ophthalmology/search.aspx?q=cataract+removal+angle-closure+glaucoma&requiredfields=specialty:Ophthalmology&client=healio_frontend&output=xml_no_dtd&proxystylesheet=healio_frontendCME&site=healio-production&lr=lang_en&filter=p&getfields=*&ie=UTF-8&ip=192.168.100.144&access=p&entqr=3&oe=UTF-8&ud=1&sort=date%3AD%3AS%3Ad1" target="_blank">cataract removal in cases of angle-closure glaucoma</a>.</p> <p style="margin: 0in 0in 10pt;">Condon cited a study published in <i>Ophthalmology</i> in 2009 by Tham and colleagues comparing phacoemulsification alone vs. phacotrabeculectomy for chronic angle-closure glaucoma. Results showed that the phacotrabeculectomy group required 1.25 fewer medications postoperatively than the phacoemulsification alone group. However, there were more complications and no difference in visual field progression with phacotrabeculectomy, Condon said.</p> <p style="margin: 0in 0in 10pt;">Condon cited several studies supporting early small-incision phacoemulsification for acute angle-closure glaucoma. In 2007, Lam and colleagues reported that 3% of eyes that underwent phacoemulsification and 29% of eyes that had laser iridectomy or iridoplasty had recalcitrant IOP elevation. However, endothelial cell loss was significant in 14% of phaco eyes and 13% of laser eyes.</p> <p style="margin: 0in 0in 10pt;">Indications for phacoemulsification in cases of angle-closure glaucoma include failed or inadequate initial treatment, 180° of angle closure despite laser treatment and chronic symptomatic mydriasis, Condon said.</p> <p style="margin: 0in 0in 10pt;">Surgical challenges in phaco for acute angle-closure glaucoma are shallow anterior chamber and difficulty maintaining the space and controlling the capsulorrhexis, Condon said.</p> <p style="margin: 0in 0in 10pt;">Postoperative concerns include high corticosteroid and NSAID use, early postoperative IOP spikes and a potential risk of malignant glaucoma.</p> <p style="margin: 0in 0in 10pt;">Condon noted that lensectomy is not suggested as first-line therapy. Early lensectomy is most effective for residual closure, and phacoemulsification is currently safer than trabeculectomy. A clear corneal incision keeps trabeculectomy in the picture as a viable option, he said.</p> <p style="margin: 0in 0in 10pt;"><strong>Disclosure</strong>: Condon is a consultant and serves on the speakers bureau for Alcon, Allergan and MST.</p> <p><em>OSN New York 2013 will be held September 6-8 at the Waldorf-Astoria in New York City. Learn more at </em><a href="https://web.archive.org/web/20130903024442/http://www.osnny.com/"><em>www.osnny.com</em></a><em>.</em></p> <p> </p> </div>  <div class="fig left"> <p class="figcaption"> </p> </div> <div class="wyPagination">   </div>  <div class="follow"> <img src="/web/20130903024442im_/http://www.healio.com/~/media/Images/News/FollowUs.jpg" id="layout_0_maincontent_1_SocialFollow_socialfollow" name="socialfollow" alt="Follow us" usemap="#followus" border="0"/> <map id="followus" name="followus"> <area id="layout_0_maincontent_1_SocialFollow_followfb" shape="rect" coords="51,5,5,51" target="_blank" href="https://web.archive.org/web/20130903024442/http://www.facebook.com/ocularsurgerynews" alt="Follow us on Facebook"></area> <area id="layout_0_maincontent_1_SocialFollow_followtw" shape="rect" coords="241,3,281,50" target="_blank" href="https://web.archive.org/web/20130903024442/https://twitter.com/OSNSuperSite" alt="Follow us on Twitter"></area> </map> </div> </div>  <div class="social-links"> <div class="fb-like" data-send="false" data-width="300" data-show-faces="true" data-action="recommend"></div> <ul class="share"> <li><a href="javascript:void(0)" id="twitter" class="twitter-link" target="_new">Tweet</a></li> <li><a href="javascript:void(0)" id="facebook" class="facebook-link" target="_new">Share</a></li> <li class="linkedin"><a href="javascript:void(0)" id="linkedin" class="linkedin-link">Link</a></li> <li><span class="db-wrapper"><span class="g-plusone" data-size="tall" data-annotation="none"></span></span></li> <li><a href="javascript:void(0)" id="email">Email</a></li> <li class="last"><a href="javascript:void(0)" id="print">Print</a></li> </ul> <input name="layout_0$maincontent_1$SocialMedia$articleItemForTweet" type="hidden" id="layout_0_maincontent_1_SocialMedia_articleItemForTweet" value="{C583F48C-1814-4632-B741-647854E764F7}"/> </div>  <div id="respond"> <h4> Comments</h4> <script language="javascript" type="text/javascript"> var idcomments_acct = 'aa6ff53f9870e40f92f83e1b5df3cddf'; var idcomments_post_id = '{C583F48C-1814-4632-B741-647854E764F7}'; var idcomments_post_url; </script> <span id="IDCommentsPostTitle" style="display: none"></span> <script type="text/javascript" src="https://web.archive.org/web/20130903024442js_/http://www.intensedebate.com/js/genericCommentWrapperV2.js"></script> <p class="comment-notes"> Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. 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Speaker reviews surgical treatment protocols for angle-closure glaucoma | Ocular Surgery News