Treating glaucoma focuses on lowering IOP to a level not likely to further damage the optic nerve. This level varies from person to person and over time. Damage caused by glaucoma is, as a rule, not reversible. Glaucoma can be held in check with eye drops, laser, or surgery.
For many people, surgery may be the best treatment for their glaucoma. There are several different types of surgery for glaucoma. The kind of surgery that is right for you will be determined by you and your doctor after considering a number of factors, including the type and severity of glaucoma, overall health, and other eye conditions. Depending on the type of surgery you and your doctor decide upon, it may be performed with either a laser or conventional surgical procedure.
The laser can be used in three different ways when treating glaucoma.
Trabeculoplasty is used most often to treat open-angle glaucoma. In this procedure, a laser is used to treat the drainage area of the eye, known as the trabecular meshwork. This causes a remodelling of the drainage pathways and makes it easier for aqueous (fluid that is produced and circulates inside the eye) to leave the eye.
Iridotomy is frequently used to treat angle-closure glaucoma. An iridotomy is also recommended in patients who have been diagnosed with narrow angles to help reduce the risk of acute angle closure. In this procedure, the surgeon uses the laser to make a small hole in the iris, which allows the aqueous to flow more freely within the eye and through the trabecular meshwork.
Cyclophotocoagulation may be used to treat more advanced or aggressive cases of glaucoma. In this procedure, a laser beam is used to treat selected areas of the ciliary body, the part of the eye that produces aqueous humor, to reduce the production of fluid and thus lower the pressure within the eye.
Laser surgery is usually performed in an outpatient surgery center or the doctor's office and requires only light anesthesia and a generally short recovery time. Patients may experience some irritation in their eyes, but can usually resume their normal activities within one or two days.
In some cases, laser surgery is not the preferred surgical treatment for glaucoma. Sometimes, when vision loss is rapid, or medication and/or laser surgery fails to lower IOP sufficiently, "conventional" incisional surgery is the best option.
Filtering surgery is done at our surgery center with local anesthesia and sedation. The most common type of filtering surgery is a trabeculectomy, where the surgeon removes a tiny piece of the wall of the eye (the sclera), leaving a tiny hole it is then covered over with the conjunctiva (transparent thin skin covering the eye). The aqueous can then drain through the hole and be reabsorbed by the body, thus reducing the intraocular pressure.
In some cases, the surgeon may place a small tube or valve in the eye through a tiny incision in the sclera. The tube acts as a regulator for the buildup of aqueous within the eye. The fluid flows through the tube and out of the eye, where it can be reabsorbed by the body. The procedure also takes place in our surgery center.
The recovery period following incisional glaucoma surgery is usually short. You may need to wear an eye shield for a few weeks after surgery and avoid activities which expose the eye to water, such as swimming. The ophthalmologist may recommend you refrain from heavy exercise, straining, bending over, or driving for a short time after surgery to avoid complications.
As with any surgery, patients should be aware that there are risks associated with glaucoma surgery. Complications are not likely but may include infection, bleeding, undesirable changes in IOP, and, in some cases, loss of vision.
Sometimes, a single surgical procedure will not effectively halt the progress of a patient's glaucoma. In these cases, a repeat surgery may be scheduled and continued treatment by medication may be prescribed.