ABSTRACT
Su rgical treatment of glaucoma has been classified as cyclodestructive(reducing inflow)or filtering(increasing outflow).Cyclodestructive procedures have traditionally been reserved for eyes with poor visual prognoses and refractory glaucomas including post-trauma,aphakia,congenital and developmental glaucoma.Since Uram described the first use of endoscopic cyclophotocoa gulation(ECP)in 1992,short and long-term outcomes for ECP have been promising.In the present article,we conduct a Pubmed search and review of published English Iiterature on endoscopic cyclophotocoagulation and comparison with limited results in a single Singapore ophthalmic tertiary hospital.Safety and efficacy of ECP and combined phacoemulsification-ECP procedures in treatment of pediatric and adult glaucomas of various etiologies and severities is reported.Local short-term unpublished results from a single Singapore tertiary ophthalmic service is reported and concurs with previously published results.Published reports and current experience with ECP has demonstrated that ECP with direct visualization of the target tissues avoids the complications associated with blind'trans-scleral cyclophotocoagulation by applying optimum energy to target tissue ciliary epithelium with endoscopic visualization and infrared laser wavelength application.Significant financial barriers exist to introducing this service.It is safe and effective in controlling IOP and reducing reliance on anti-glaucoma medications.Wide spread acceptance and use of this technique awaits large scale randomized controlled studies.
ABSTRACT
·AIM:To describe an unusual combination of retinal manifestations in an AIDS patient with progressive outer retinal necrosis (PORN),complicated by combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO).·METHODS:A case report.·RESULTS:The patient presented with PORN with primary optic nerve involvement complicated by combined central retinal artery occlusion(CRAO) and central retinal vein occlusion(CRVO) as a primary manifestation of Varicella Zoster Virus (VZV).Aggressive treatment with intravitreal and specific systemic anti-VZV therapy,in addition to systemic highly active antiretroviral therapy (HAART) achieved retinal quiescence with sparing of the fellow eye.Visual outcome of the affected eye was poor.·CONCLUSION:We present the first report of PORN associated with the unusual combined complications of CRAO and CRVO. Aggressive local treatment was combined with systemic therapy,which achieved local control and empirical prophylaxis for the fellow eye.