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These operations are indicated in congenital and developmental glaucomas. FILTERING OPERATIONS Filtering operations provide a new channel for aqueous outflow and successfully control the IOP (below 21 mm of Hg). Fistulizing operations can be divided into three groups : 1. Free-filtering operations (Full thickness fistula) medical terminology. These are no longer performed now-a-days, because of high rate of postoperative complications. Their names are mentioned only for historical interest. These operations included pseudophakic eyes with vitreous haemorrhage. After about 2 weeks of haemorrhage the RBCs degenerate, lose their pliability and become khaki-coloured cells (ghost cells) which pass from the vitreous into the anterior chamber, and block the pores of trabeculae leading to rise in IOP. 2. Hemosiderotic glaucoma. It is a rare variety of secondary glaucoma occurring due to sclerotic changes in trabecular meshwork caused by the iron from the phagocytosed haemoglobin by the endothelial cells of trabeculum. GLAUCOMAS ASSOCIATED WITH IRIDOCORNEAL ENDOTHELIAL SYNDROMES Iridocorneal endothelial (ICE) syndromes include three clinical entities: Progressive iris atrophy, Chandler’s syndrome, and Cogan-Reese syndrome. Pathogenesis. The common feature of the ICE syndromes is the presence of abnormal corneal endothelial cells which proliferate to form an endothelial membrane in the angle of anterior chamber. Glaucoma is caused by secondary synechial angle-closure as a result of contraction of this endothelial membrane. Clinical features. The ICE syndromes typically affect middle-aged women. The raised IOP is associated with characteristic features of the causative condition.In ‘progressive iris atrophy’, iris features predominate with marked corectopia, atrophy and hole formation. While in Chandler’s syndrome, extreme weight loss changes in iris are mild extreme weight loss to absent and the corneal oedema even at normal IOP predominates. Hallmark of Cogan-Reese syndrome is nodular or medical terminology diffuse pigmented lesions of the iris (therefore also called as iris naevus syndrome) which may or may not be associated with corneal changes. Treatment is usually frustating : Medical treatment is often ineffective Trabeculectomy operation usually fails, Artificial filteration shunt may control the IOP.� 238 Comprehensive OPHTHALMOLOGY Elliot's sclero-corneal trephining, punch sclerectomy, Scheie's thermosclerostomy and iridencleisis. 2. Guarded filtering medical terminology surgery (Partial thickness fistula e.g., trabeculectomy). 3. Extreme weight loss Non-penetrating filtration surgery e.g., deep sclerectomy and viscocanalostomy. From how to become a psychiatrist