GLAUCOMA SURGERY

Understanding Glaucoma Surgery and Treatment Options

Glaucoma surgery involves either laser treatment or making a precise incision in the eye to effectively reduce intraocular pressure. The specific type of surgery recommended by your specialist depends on the type and severity of your glaucoma, as well as the general health of your eye. While surgery is a vital tool to lower pressure when medication is insufficient, it is important to note that it cannot reverse existing vision loss.

Laser Surgery for Glaucoma

Doctors often prioritize laser surgery before considering incisional methods, unless the eye pressure is exceptionally high or the optic nerve is severely damaged. During this procedure, a focused beam of light treats the eye's trabecular meshwork (the drainage system) to increase fluid outflow. These outpatient procedures are performed in a clinic or hospital setting using numbing drops to ensure little to no pain.

Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) is used for treating primary open-angle glaucoma (POAG). This method utilizes low-level laser energy to treat specific cells selectively, leaving the rest of the trabecular meshwork intact. Key features of SLT include:

• It can be safely repeated due to its selective nature.
• It serves as an alternative for patients who have not responded well to ALT or pressure-lowering drops.

Argon Laser Trabeculoplasty (ALT)

Also used for primary open-angle glaucoma (POAG), Argon Laser Trabeculoplasty (ALT) opens fluid channels to improve the drainage system's efficiency.

• Success Rate: Successfully lowers eye pressure in up to 75% of patients.
• Procedure: Usually, half of the fluid channels are treated first to prevent over-correction and minimize the risk of post-surgical pressure spikes.
• Follow-up: In many cases, medication may still be required following the procedure.

Laser Peripheral Iridotomy (LPI)

Laser Peripheral Iridotomy (LPI) is the standard treatment for narrow-angle glaucoma (angle-closure glaucoma). This condition occurs when the angle between the iris and cornea is too small, causing the iris to block fluid drainage. LPI creates a small hole in the iris, allowing it to fall back and opening the fluid channel for better drainage.

Laser Cyclophotocoagulation

This procedure serves as an alternative to filtering microsurgery and is typically used later in the treatment algorithm. It uses lasers to hamper the ciliary body's ability to produce fluid, thereby lowering eye pressure. This procedure may require repetition to achieve permanent control over glaucoma.

Risks Associated with Laser Surgery

While laser surgery is a common and effective intervention, it does carry certain risks. The most notable side effect is a short-term increase in intraocular pressure (IOP) shortly after the procedure.

Incisional Surgery (Filtering Surgery)

Incisional surgery, also known as filtering surgery, involves creating a new drainage hole using small surgical tools. This artificial canal allows intraocular fluid to bypass clogged natural drainage paths.

Occasionally, glaucoma surgery must be repeated, especially if long periods have passed or if scarring prevents the new drainage hole from functioning correctly.

Op. Dr. Ahmet Umay
NICOSIA / CYPRUS
Resource: Glaucoma.org