Glaucoma Surgery
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Glaucoma Surgery

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Definition

A procedure to treat glaucoma by lowering pressure inside the eye. There are two common methods: laser and incisional.

The interior of the eye is normally bathed by the aqueous humor, a clear fluid that flows in and out of the anterior chamber of the eye. In most cases of glaucoma , this fluid drains too slowly out of the eye. As the fluid builds up, pressure inside the eye increases. If this pressure is not controlled, it can cause damage to the optic nerve and possibly other parts of the eye, and loss of vision. It is important to note that while glaucoma surgery may save your remaining vision, it does not improve or restore sight.

Glaucoma

Glaucoma

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

Eye (conjunctiva, iris, sclera, trabecular meshwork)

Reasons for Procedure

  • To lower the amount of pressure in the eye
  • To reduce and/or prevent loss of vision

Risk Factors for Complications During the Procedure

Risk factors for complications include, but are not limited to:

What to Expect

Prior to Procedure

  • Continue to take your eye drops, unless directed otherwise by your doctor.
  • If you are having the incisional technique, your doctor will probably advise you not to take aspirin, aspirin-containing products, anti-inflammatory drugs (eg, ibuprofen), or certain herbal products 10 days before the procedure. However, do not stop any medications without first discussing it with your doctor.
  • Arrange for a ride to and from the procedure.

During Procedure

A small device is placed in the eye to hold the eyelid open.

Anesthesia

Drops are used to numb the eye for both incisional and laser procedures. Local and/or IV sedation may be used for incisional surgery. General anesthesia is used under some circumstances.

Description of the Procedure

There are two common types of glaucoma surgery: laser and incisional. Both are usually performed as outpatient procedures.

Laser Surgery

The main types of laser surgery include:

Argon Laser Trabeculoplasty (ALT)

Argon laser trabeculoplasty (ALT) is the most common type of laser surgery and is usually used to treat open angle glaucoma. During this procedure, you sit facing the laser machine. The laser "spot" is applied to a special contact lens held on the front of the eye and reflected onto the drainage meshwork inside the eye. You may see flashes of red or green light as the laser is applied. This procedure allows more fluid to be released and relieves some of the pressure.

Selective Laser Trabeculoplasty (SLT)

Selective laser trabeculoplasty (SLT) is a relatively new treatment that is similar in mechanism to ALT. SLT has the benefit of being repeatable, whereas ALT cannot be performed more than twice.

Laser Peripheral Iridotomy (LPI)

Laser peripheral iridotomy (LPI) is frequently used to treat narrow-angle glaucoma or to prevent glaucoma attacks in patients with anatomically narrow angles. Narrow-angle glaucoma occurs when the angle between the cornea (the clear structure on the front of the eye) and the iris (the colored part of the eye) is too small. This can cause the iris to "plug up" the drainage meshwork inside the eye, so fluid cannot flow freely. This can cause the pressure to rise to dangerously high levels very quickly. In LPI, the surgeon uses the laser to make a small hole in the iris, which allows fluid to flow more freely within the eye.

Cyclophotocoagulation

Cyclophotocoagulation freezes selected parts of the eye that produce the aqueous humor, thereby reducing the production of fluid. This procedure is usually done only in people who have severe damage from glaucoma and for whom other surgeries were not successful. Instead of freezing, this procedure can also be performed with a laser.

Incisional Surgery

Also known as filtering surgery, incisional surgery requires the use of tiny instruments to remove a tiny piece from the wall of the eye, leaving a small hole, which is covered by conjunctiva. The aqueous humor can now drain out through the hole and be reabsorbed into the bloodstream. This reduces the pressure in the eye. In some cases, the surgeon may place a valve in the eye through a tiny incision.

After Procedure

Eye and pressure exam, eye drops, eye patch

How Long Will It Take?

The procedure usually takes less than one hour, although people having the incisional procedure are often told to allow about 4-8 hours from the time of arrival until discharge.

Will It Hurt?

Most patients report no pain throughout either procedure (due to the local anesthesia they are given), although there may be some burning or stinging with ALT and LPI. Some patients report mild discomfort during the procedures. Incisional glaucoma surgeries tend to have more postoperative discomfort than the laser procedures.

Possible Complications

  • Sensitivity to light
  • Scratchiness
  • Undesirable changes in intraocular pressure
  • Red, inflamed eyes
  • Infection
  • Inflammation
  • Bleeding
  • Loss of vision
  • Loss of eye
  • Need for more surgery

Average Hospital Stay

None

Postoperative Care

  • If given an eye patch or bandage, wear it as directed by your doctor.
  • Use eyedrops as prescribed; these drops will often help prevent infection and inflammation.
  • Avoid activities that expose your eye to water like swimming.
  • Refrain from heavy lifting, straining, or driving until allowed by your physician.
  • Follow your surgeon's advice regarding resumption of exercise and other activities.

Outcome

Laser trabeculoplasty often relieves intraocular pressure, but the effects can wear off over time. In most cases, medications are still necessary to control and maintain eye pressure. Surgery is more likely to eliminate the need for medications, but not always.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Sudden change in vision
  • Pain in your eye
  • Bleeding
  • Redness, swelling, increasing pain, excessive bleeding, or discharge in the surgical area
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting

RESOURCES:

The Glaucoma Foundation
http://www.glaucomafoundation.org

Naitonal Eye Institute
http://www.nei.nih.gov

CANADIAN RESOURCES

Canadian Ophthalmological Society
http://www.eyesite.ca/

University of Ottawa Eye Institute
http://www.eyeinstitute.net/main.html

References:

American Academy of Ophthalmology website. Available at: http://www.aao.org/ .

National Eye Institute website. Available at: http://www.nei.nih.gov .

Ophthalmology Clinics of North America. 2005;18:409-419.



Last reviewed December 2007 by Alexander J. Anetakis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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