GLAUCOMA SURGERY:

Surgery involves either laser treatment or making a cut in the eye to reduce the intraocular pressure. The type of surgery your doctor recommends will depend on the type and severity of your glaucoma and the general health of your eye. Surgery can help lower pressure when medication is not sufficient. However, it cannot reverse vision loss.

LASER SURGERY:

Doctors often recommend laser surgery before incisional surgery, unless the eye pressure is very high or the optic nerve is badly damaged. During laser surgery, a focused beam of light is used to treat the eye's trabecular meshwork (the eye's drainage system). This helps increase the flow of fluid out of the eye. Laser surgeries have become important in the treatment of different eye problems and diseases. There are several types of laser surgery used to treat glaucoma. The type of laser surgery will depend on the form of glaucoma and how severe it is. Lasers produce a focused beam of light that can make a very small burn or opening in your eye tissue, depending on the strength of the light beam. Laser surgeries are performed in an outpatient setting in your doctor’s office or in a hospital clinic. During the laser surgery, the eye is numbed so that there is little or no pain.The eye doctor then holds a special lens to the eye. The laser beam is aimed into the eye, and there is a bright light, like a camera flash.

SELECTIVE LASER TRABECULOPLASTY (SLT)

For the treatment of primary open-angle glaucoma (POAG). SLT uses a laser that works at very low levels. It treats specific cells "selectively,” leaving untreated portions of the trabecular meshwork intact. For this reason, SLT may be safely repeated. SLT may be an alternative for those who have been treated unsuccessfully with ALT or pressure-lowering drops.

ARGON LASER TRABECULOPLASTY (ALT):

For the treatment of primary open-angle glaucoma (POAG). The laser beam opens the fluid channels of the eye, helping the drainage system work better. In many cases, medication will still be needed. Usually, half the fluid channels are treated first. If necessary, the other fluid channels can be treated in a separate session another time. This method prevents over-correction and lowers the risk of increased pressure following surgery. Argon laser trabeculoplasty has successfully lowered eye pressure in up to 75% of patients treated.

LASER PERIPHERAL IRIDOTOMY (LPI)

For the treatment of narrow angles and narrow-angle glaucoma. Narrow-angle glaucoma (also known as angle-closure glaucoma) occurs when the angle between the iris and the cornea in the eye is too small. This causes the iris to block fluid drainage, increasing inner eye pressure. LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain.

LASER CYCLOPHOTOCOAGULATION

An alternative to filtering microsurgery that is typically used later in the treatment algorithm. Several different types of lasers can be used to hamper the ciliary body's ability to make fluid and, thus, lower the eye pressure. The procedure may need to be repeated in order to permanently control glaucoma.

RISKS OF LASER SURGERY

As with any type of surgery, laser surgery can carry some risks.Some people experience a short-term increase in their intraocular pressure (IOP) soon after surgery.

INCISIONAL SURGERY

In contrast, incisional surgery (also called filtering surgery) involves creating a drainage hole with the use of a small surgical tool. This new opening allows the intraocular fluid to bypass the clogged drainage canals and flow out of this new, artificial drainage canal. When laser surgery does not successfully lower eye pressure, or the pressure begins to rise again, the doctor may recommend incisional surgery. Occasionally, glaucoma surgery may have to be repeated especially if excessive scarring cannot be prevented or after long periods of time. With my best wishes.

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