either can be the first to occur. as the get bigger and join together an arcuate scotomoa develops.
REMEMBER: You can have glaucoma and have normal visual fields. Damage first occurs to the nerve fiber layer of the retina, then optic nerve cupping only the VF damages. As many as 25-50% of the nerve fibers may need to be damaged before VF changes occur
Dear sir; I have a suggestion about the trabeculectomy.
Present procedure we are doing:
1. Making a triangular or quadriangular flap dissected from scleral end.
2. Than making trabeculectomy with sclerotomy.
3. Than suture the flap with adjacent borders.
Disadvantages of Present Procedure:
1. We suture the flap with its margin without creating a space betweem flap and inferior surface of flap .
2. We wait for bleb formation on the aqueous flow, which is aleready reduced due to inflammation of anterior chamber as well cilliary body and facilitates adhesion between flap and globe so it makes increase risk of diffuse flate bleb.
3. Their is less space which increase early chances of adhesion of flap and making failed trabeculectomy.
Suggestion for future:
1. Making quadriangular flap don't dissected from sclerin its posterior edge only dissecte from sides.
2. Than disecte this flap in its junction of anterior 2/3 and posterior 1/3 and make two flaps one is anterior other one is posterior.
3. Than remove 1-2mm portion from the anterior flap which you have made.
4. Than two sutures place to the flaps anterior and posterior with each other.
5. Than two sutures place to each flap from their sides.
Advantages of procedure:
1. To create the space between flap and inferior surface to flap by removing a portion of flap.
2. By making a space within the bleb which is indpendent to aqueous flow we reduces the risk of diffue flat bleb postoperatively.
3. By making a cavity we increases the age of bleb which is reduced by fibrous proliferation.
dear sir think about suggestion and inform me if that is beneficial for patient than i whould perform or if their is need of other modification please inform me. Thanks.
The best place for a message like that is in peer reviewed ophthalmology journal.