Glaucoma Surgery

“Glaucoma Surgery” is performed to reduce intraocular pressure (IOP) and prevent further damage to the optic nerve, which can help preserve vision in individuals with glaucoma.

There are several types of glaucoma surgeries, and the appropriate choice depends on the type and severity of glaucoma, as well as the patient’s overall health and response to other treatments. 

Here’s an overview of the different types of glaucoma surgeries and what to expect:

Types of Glaucoma Surgery

1. Laser Surgery

• Trabeculoplasty:
  • Used primarily for open-angle glaucoma.
  • A laser is used to open the drainage angle of the eye to improve the outflow of aqueous humor.
• Iridotomy:
  • Used for narrow-angle or angle-closure glaucoma.
  • A laser creates a small hole in the iris to help fluid flow to the drainage angle.
• Cyclophotocoagulation:
  • Used when other surgeries are not effective.
  • A laser is used to reduce the production of aqueous humor by targeting the ciliary body.

2. Filtering Surgery

• Trabeculectomy:
  • A part of the trabecular meshwork is removed to create a new drainage pathway for the aqueous humor.
  • This procedure creates a small flap in the sclera (white part of the eye) and an opening underneath to allow fluid to drain into a bleb (a small bubble or reservoir) on the surface of the eye.

3. Minimally Invasive Glaucoma Surgery (MIGS)

• iStent, Hydrus Microstent, Xen Gel Stent:
  • Small devices are implanted to enhance the drainage of aqueous humor.
  • These procedures involve less tissue manipulation and have a quicker recovery time compared to traditional surgeries.

4. Drainage Implant Surgery

• Glaucoma Drainage Devices (e.g., Ahmed, Baerveldt, Molteno implants):
  • Tubes are inserted into the eye to direct fluid to a reservoir (bleb) outside the eye, from where it is absorbed into the surrounding tissue.

Procedure steps

Pre-Surgery Preparation

1. Comprehensive Eye Examination:
   • The ophthalmologist will conduct a thorough examination of your eyes to determine the type and extent of glaucoma.
2. Medical Evaluation:
   • Your medical history and current medications will be reviewed to ensure there are no contraindications for surgery.
3. Pre-Surgical Instructions:
   • You may be advised to stop taking certain medications, such as blood thinners, before the surgery.
   • Instructions on fasting or using specific eye drops before surgery might be provided.

The Surgery

1. Anesthesia:
   • Usually performed under local anesthesia (numbing eye drops or an injection).
   • Sedation may be provided to help you relax.
2. Procedure:
   • Depending on the type of surgery, the ophthalmologist will either use a laser or make small incisions in the eye to create a new drainage pathway or insert drainage devices.
3. Duration:
   • Most glaucoma surgeries are completed within 30 minutes to an hour.

Post-Surgery Care

1. Immediate Recovery:
   • You will rest for a short period in a recovery area, and your eye may be covered with a protective shield.
2. Post-Operative Instructions:
   • You will be prescribed eye drops to prevent infection, reduce inflammation, and control eye pressure.
   • Avoid strenuous activities, bending over, lifting heavy objects, or rubbing your eye.
3. Follow-Up Visits:
   • Multiple follow-up appointments will be scheduled to monitor the healing process and effectiveness of the surgery.
   • Additional treatments or adjustments to medications may be necessary based on the results.

Potential Risks and Complications

While glaucoma surgery is generally safe, potential risks include:

• Infection
• Bleeding
• Inflammation
• Eye pressure that is too low (hypotony)
• Scarring that can affect the drainage of aqueous humor
• Vision loss or decrease in vision

Benefits of Glaucoma Surgery

• Reduced Intraocular Pressure: Surgery can effectively lower IOP, reducing the risk of further optic nerve damage.
• Preservation of Vision: By controlling IOP, glaucoma surgery helps preserve existing vision and prevent further vision loss.
• Improved Quality of Life: Maintaining stable vision can enhance the quality of life and independence.

Conclusion

Glaucoma surgery is a crucial intervention for patients whose intraocular pressure cannot be controlled with medications or laser treatments alone. It can significantly reduce the risk of vision loss due to glaucoma. SHIFA helps you adhering to pre- and post-operative care instructions and attending all follow-up appointments which are essential for the best outcomes.