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 1

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
He think it was a 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
Limites de la OCT

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

8. ? Is there an ideal bleb? IOP - height positive correlation,
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
Supraciliary implantation reduces intrascleral lake dependency, being a simultaneous drainage alternative to the subconjunctival pathway.
_ High intrascleral bleb
_ Uveoescleral outflow

10. Morphological intrascleral bleb changes
IOP 12
No treatment
IOP 16
No treatment
IOP 20
Goniopuncture
IOP 18
Latanoprost
At the end our enemy nfibrosis

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

12. Implant localization _Suprachoroidall _Supraciliary _ Implant over TDM
˃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

14. Implant localization _ Anterior implant displacement
_ Anterior implant displacement
_ Posterior implant displacement

15. Assessment Pre/Post Needling
_ Ciliary body prolapse

16. Assessment Pre/Post Needling

17. Assessment Pre/Post Goniopuncture

18. Assessment Pre/Post Goniopuncture

19. Assessment Pre/Post Goniopuncture

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. Always CLINICAL approach
Take Home Message
Luxury
Dependences
Necessity
Always CLINICAL approach

24. Moltes gràcies