EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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92 EW MEETING REPORTER Reporting live from the 2013 APAO-AIOS Congress, Hyderabad, India February 2013 Pacific region, one that has widereaching effects on and associations with a variety of other ophthalmic conditions. One significant cause of secondary glaucoma is iridocorneal endothelial (ICE) syndrome. In this condition, secondary glaucoma develops when abnormal cells proliferate, crossing the Schwalbe���s line and covering the trabecular meshwork and obstructing the anterior chamber angles, said Dennis S.C. Lam, M.D., Hong Kong, secretary-general of APAO. In addition, peripheral anterior synechiae can form. ���On one hand, you have an open angle component,��� he said. ���On the other hand, you can actually have anatomical changes, making this a closed angle situation.��� The treatment options are the same as for ordinary glaucoma, although because the ICE syndrome is progressive, most are only useful at the beginning. Trabeculectomy, for instance, is usually successful only initially, with failure occurring as early as six months after the first procedure, said Dr. Lam. Trabeculectomy fails not only because of the progressive nature of ICE, but because of the extensive fibrosis seen in these relatively young patients; there can be aggressive PAS. ���Trabeculectomy will fail eventually,��� said Dr. Lam. While medical management and other procedures are successful in the beginning, Dr. Lam said that some doctors ���want to use drainage devices as their first line.��� However, the tube is at risk for tip lumen obstruction by proliferating abnormal cells, and tube migration caused by this same proliferation or PAS formation can also occur. ���If you are using this procedure, I think it is a good idea to communicate to your patient that this may occur and require further surgery,��� said Dr. Lam. As a way of minimizing or circumventing this risk, Dr. Lam suggested using a longer tube shunt. In pseudophakes, the tube could be placed initially in the sulcus or pars plana���the latter case requiring full vitrectomy. Editors��� note: Dr. Lam has no financial interests related to his talk. Indian physician sees evolution of ophthalmology in India over long career When R. B. Jain, M.D., Delhi, India, was 10 years old, he visited his maternal grandfather on holiday. His grandfather needed building materials for a house, so he asked Dr. Jain to go with him. His grandfather, a prominent, well-educated postmaster in his town in India, was 90% blind from glaucoma. He had to hold Dr. Jain���s hand, and Dr. Jain led him to the shop. Dr. Jain selected the best wood for his grandfather. He signed forms to ensure the wood was delivered. He was, in essence, his grandfather���s eyes, and the difficulty of the situation, and the unfairness of it��� why anyone would go blind and be so helpless that they could not be independent in such every day activities as walking or shopping���