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Medical Forum / Diseases and Disorders / Glaucoma / September 2003

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tube tribulations

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Simon - 13 Aug 2003 14:34 GMT
A few months ago I had a bearveldt tube put in but after some months the
pressure was raised to 40. I was told the bleb was a little small which was
reducing it's capacity.

They took out the stitch they put in the tube and it went down to 20-25 but
the pressure is back up again - 35 - and they still say my bleb looks small.

My regular Dr was not there but I go back to see him friday and I'd love
some idea what my options might be as I am getting a bit pessimistic and
disheartened.

The Dr I saw today said it may require needling and 5FU, he put me on
alphagan which seems to help.
Rick Cohn, M.D. - 15 Aug 2003 03:18 GMT
> A few months ago I had a bearveldt tube put in but after some months the
> pressure was raised to 40. I was told the bleb was a little small which was
[quoted text clipped - 9 lines]
> The Dr I saw today said it may require needling and 5FU, he put me on
> alphagan which seems to help.

Here's the deal with most tubes (doesn't matter what type)...generally
the IOP is a fair bit lower, but seldom do the patients get off drops.
I tell my patients to expect to go from poor control on 3 drops to
reasonable control on two drops.  Usually there are none required for
the first month or so, but in glaucoma the rule is "What goes down
must come up."  That's the IOP.  So if you were on no meds after the
surgery, don't be too disappointed if your back on 2 or 3 eventually.
That's often the norm.  I have not found that needling and 5FU work
after tubes as well as after a trab, but I wouldn't rule it out as a
possibility.  I used to use mitomycin C on all of my tubes during
surgery, which according to research works up to 10 times better than
5 FU, but these patients still needed most of their glaucoma meds
added back.  Anyway, good luck, and let me know what happens.
Rick Cohn, MD
Glaucoma Specialist
Winter Park, FL
Simon - 20 Aug 2003 20:46 GMT
> > A few months ago I had a bearveldt tube put in but after some months the
> > pressure was raised to 40. I was told the bleb was a little small which was
[quoted text clipped - 26 lines]
> Glaucoma Specialist
> Winter Park, FL
Dr Rick, thanks for the info and explanation.
I have now been taken off steroids - it's now almost 6 months since the tube
went in and my doctor expects this will help. In the meantime I am on drops
to help lower the pressure and go back in a few more weeks for another
assessment, he hopes that once the steroids wear off the pressure will come
down a little.
Please do you know how long PreForte takes to wear off when you have been
taking it for quite a while?.
Rick Cohn, M.D. - 23 Aug 2003 18:46 GMT
> > "Simon" <no.spam.l@ever.net> wrote in message
>  news:<L7r_a.318$EB6.4337686@newsfep1-win.server.ntli.net>...
[quoted text clipped - 39 lines]
> Please do you know how long PreForte takes to wear off when you have been
> taking it for quite a while?.

The answer is quite a while...many say that it takes as long for the
steroid-induced effect of IOP elevation to wear off as the length of
time you were on the steroids.  So if you were on them for six weeks,
it might take six weeks to wear off.  Good luck.
--Rick Cohn, MD
Simon - 15 Sep 2003 23:44 GMT
> > > "Simon" <no.spam.l@ever.net> wrote in message
> >  news:<L7r_a.318$EB6.4337686@newsfep1-win.server.ntli.net>...
[quoted text clipped - 45 lines]
> it might take six weeks to wear off.  Good luck.
> --Rick Cohn, MD

Well, here I am a month later and with Alphagan my pressure was in single
figures.
Rick Cohn, M.D. - 17 Sep 2003 03:15 GMT
> > "Simon" <no.spam.l@ever.net> wrote in message
>  news:<zeQ0b.16089$Kx1.253610@newsfep4-glfd.server.ntli.net>...
[quoted text clipped - 61 lines]
> Well, here I am a month later and with Alphagan my pressure was in single
> figures.

Good show!  That's great news...hope it stays there.
--Rick
Simon - 29 Sep 2003 23:43 GMT
> > > "Simon" <no.spam.l@ever.net> wrote in message
> >  news:<zeQ0b.16089$Kx1.253610@newsfep4-glfd.server.ntli.net>...
[quoted text clipped - 64 lines]
> Good show!  That's great news...hope it stays there.
> --Rick

I was taken off drops and it's still 13! I actually feel 13 is quite lucky!
 
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