For some people, surgery might be the best treatment for glaucoma. Your ophthalmologist may suggest surgery as a first treatment, or after trying medication to lower your IOP. There are several different types of surgery for glaucoma. The kind of surgery you and your ophthalmologist decide is right for you depends on many factors, including the type and severity of your glaucoma, and other eye problems or health conditions.
Glaucoma surgery may be performed using a laser (a concentrated beam of light) or conventional surgical instruments.
Laser Surgery
Trabeculoplasty is used most often to treat open-angle glaucoma. In trabeculoplasty, a laser is used to place spot welds in the drainage area of the eye– also known as the trabecular meshwork — that allow the aqueous to drain more freely.
Iridotomy is another kind of laser surgery used in treating glaucoma. It is frequently used to treat angle-closure glaucoma. In this procedure, the surgeon uses the laser to make a small hole in the iris– the colored part of the eye — which allows the aqueous to flow more freely within the eye so the iris doesn’t plug up the trabecular meshwork.
In cyclophotocoagulation, 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. This procedure may be used to treat more advanced or aggressive cases of glaucoma.
Most laser surgeries for glaucoma can be performed in the ophthalmologist’s office or an outpatient surgical facility. Eye drops are used to numb the eye for the duration of the procedure. Because there is usually little discomfort during glaucoma surgery, this is often the only anesthesia needed
Little recuperation is needed after laser eye surgery. Patients may experience some local eye irritation, but can usually resume their normal activities a day or two after surgery.
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.
Incisional Surgery
Filtering surgery is usually done in a hospital or outpatient surgery center, with local anesthesia, and sometimes, sedation. The surgeon uses very delicate instruments to remove a tiny piece of the wall of the eye (the sclera), leaving a tiny hole. The aqueous can then drain through the hole, reducing the intraocular pressure, and be reabsorbed into the bloodstream.
In some cases, the surgeon may place a small tube or valve in the eye through a tiny incision in the sclera. The valve acts a regulator for the buildup of aqueous within the eye. When the intraocular pressure reaches a certain level, the valve opens, allowing the fluid to flow out of the eye’s interior, where it can be reabsorbed by the body. The procedure may take place in the ophthalmologist’s office or outpatient surgical center, and can be done under local anesthesia.
The recuperative period following incisional glaucoma surgery is usually short. You may need to wear an eye patch for a few days after surgery, and to avoid activities which expose the eye to water, such as showering or swimming. The ophthalmologist may recommend that you refrain from heavy exercise, straining or driving for a short time after surgery, to avoid complications.
Possible Complications
As with all surgery, there are risks associated with glaucoma surgery. Complications are unusual, but can include:
* infection
* bleeding
* undesirable changes in intraocular pressure
* loss of vision
Sometimes, a single surgical procedure is not effective in halting the progress of an person’s glaucoma. In these cases, repeat surgery, and/or continued treatment with topical or oral medications may be necessary.
Your age, eye structure, type of glaucoma, and other medical conditions are all considerations when deciding how to treat your glaucoma.
The ophthalmologist, in partnership with the patient, is best able to make the appropriate treatment decisions.
