Glaucoma Treatment

Glaucoma is described as a whole group of diseases affecting the eye, but all share the common fact that they cause the pressure within the eye (the intraocular pressure) to be at unhealthy levels. As many different types of glaucoma exist, treatments depend on the type of the glaucoma as well as a variety of other factors.

Normally, watery fluid (aqueous humour) constantly flows through the eye. This fluid keeps the eye firm and clear so the eyeball can visually function well. The relative state of inflow and outflow of aqueous humour partially determines how firm the eye is. If the outflow is blocked, pressure inside the eye builds up. The pressure within the eye, the intraocular pressure, can directly damage the optic nerve, the nerve that carries the electrical impulses from the light-sensitive part of the eye to the brain, where the electrical impulses are put together to form a picture. Even when the intraocular pressure is not above average, it may still be high enough to cause optic nerve damage. Elevated intraocular pressure can damage other tissues as well, such as the cornea and the lens, and can squeeze out of the eye the blood needed to keep the nerves healthy, resulting in damage to the nerves or retina (the light-sensitive part of the eye).

Outflow of fluid, aqueous humour, can be blocked in different ways: The pupil, the hole through which the fluid flows as it passes from the back to the front of the iris (the coloured part of the eye) can get blocked by adhesions or by a cataract. The sieve through which the fluid drains can become blocked by debris caused by inflammation, by deposits which are due to aging, by abnormal material which is sometimes the result of certain drugs, or by the iris itself. The veins into which the fluid flows when it leaves the eye can be partially blocked by other disease, or by pressure on the large veins in the orbit.

• Glaucoma Surgery at a Glance

  PROCEDURE:	Cut a small window in the sclera (the white outer covering of the eyeball) and remove part of trabecular meshwork to allow fluid to escape
  LENGTH:	20 to 30 minutes
  ANESTHESIA:	Local or local with sedation
  IN/OUTPATIENT:	Usually outpatient
  SIDE EFFECTS:	Sensitivity to light, bleeding, irritation
  RISK:	Bleb Leak (blister-like bumps), infection, scarring, cataract formation
  RECOVERY:	Visual settling time: 1 to 2 day(s) Back to work: 1 to 15 day(s)
  RESULT LASTS:	50 % of patients no longer need medication after surgery

• What is Glaucoma Surgery?

  Surgery is performed either as laser treatment or making a cut in the eye so as to reduce the intraocular pressure. The type of surgery will depend on the type and severity of patient’s glaucoma and the general health of the patient’s eye. Surgery may aid lower pressure when medication is not satisfactory. However, it can not heal vision loss. The most common treatments are:

  • Filtration procedure (trabeculectomy): This surgery opens the full thickness of the drainage area.
  • Laser trabeculoplasty: This surgery partially opens the drainage area. It does not reduce pressure to the extent of trabeculectomy but it has fewer side effects.

• Treatment Options

  There are three methods of treatment for glaucoma;

  • Medication: There are various types of eye drops used in the treatment of glaucoma. These medicines reduce the intraocular pressure through different mechanisms. They are regularly used in pre-determined intervals for lifetime. It is attempted to reduce the intraocular pressure.  If this cannot be achieved, a second type of eye drop is added to the treatment. If the eye pressure cannot be reduced again, according the opinion of the doctor, a third type of eye-drop may be added or other treatment methods may be implemented.
  • Laser treatment: Laser procedure in glaucoma treatment is an option if the patient is not treated by medication only. This method is highly successful when implemented without delay.
  • Surgical Treatment: In the surgical operation, a hole is opened in the white part of the eye. Through this hole, that is so small that cannot be seen, the extra liquid in the eye is drained.

• How it is Performed

  Laser surgery for glaucoma treatment is performed in an outpatient setting. The eye is numbed during the laser surgery so that there is little or no pain. The eye surgeon then holds a special lens to the eye. The laser beam is pointed into the eye and there is a bright light, like a camera flash, from 80 to 100 tiny holes where burn in the drainage area and small scars form, increasing fluid outflow. The laser surgery takes about 15 minutes, causes almost no discomfort, and has very few complications.

  In surgical treatment, a tiny drainage hole is made in the sclera (the white part of the eye) in a surgery called a trabeculectomy or a sclerostomy. The new drainage hole let fluid to flow out of the eye and aids lower eye pressure which prevents or reduces damage to the optic nerve. In most cases, patient does not feel any pain. The procedure is usually performed with local anaesthesia and relaxing medications. Often intravenous sedation is used during the surgery. In addition, an injection is given around or behind the eye so as to prevent any eye movement. The injection is not painful when intravenous sedation is applied first. The patient will be relaxed and will not feel any pain during surgery.

• Results

  Glaucoma laser surgery helps to reduce the intraocular pressure in the eye. The result of laser treatment depends on the type of laser surgery, the type of glaucoma, age, race, and many other factors. Some patients may require the procedure to be repeated to better control the intraocular pressure. Patients usually can return daily activities the next day after laser procedure. Patient’s eye might be a bit irritated and vision might slightly become blurry after the procedure.

  After glaucoma surgery, patients are recommended to keep water out of the eye at least one week. Most daily activities can be done, nevertheless, it is vital to avoid driving, reading, bending, and doing any heavy lifting. The eye will be red and irritated after surgery and there might be increased eye tearing or watering.

  Some vision changes may occur due to procedure such as blurred vision which can last about six weeks after the surgery. Vision will generally return to the same condition as it was before surgery. Vision may sometimes get better after surgery in patients who had been using pilocarpine. In a very few cases, the vision might be worse because of very low pressure. Cataracts or wrinkle in the macula area of the eye may develop as side effects.

• Limitations

  There are a few limitations about the glaucoma surgery. Trabeculoplasty can not be performed more than two times per eye. Any scarring to the conjunctiva might limit the ability to perform future filtering surgery.

• Risks

  As with any type of surgery, laser surgery for glaucoma treatment carries some risks. Some patients may have a short-term increase in their intraocular pressure right after surgery. The use of anti-glaucoma medication before and after surgery may help reduce the associated risks with the laser glaucoma surgery.

  The most common problem after a trabeculectomy surgery is scarring of the opening. Scarring prevents fluid drainage from the eye and interferes with the appropriate function of the bleb. Mitomycin-C is usually used during surgery to prevent scarring. Other risks related with glaucoma surgery are:

  • Severe blurring of vision for several weeks
  • Bleeding in the eye
  • Extremely low pressures in the eye, which may result in blurred vision that results from clouding of the lens (cataract), fluid build-up under the nerve layer in the eye (retina)
  • Sudden, permanent loss of central vision. This risk depends on how much central vision had been lost before surgery
  • Infection
  • High pressure in the eye, causing the space in the front part of the eye (anterior chamber) to collapse (malignant glaucoma)

• Contraindications

  As with any other surgical treatment, the patient must be in a stable-enough medical condition to undergo a glaucoma surgical procedure. Relative contraindications to glaucoma-filtering surgery are intraocular neoplasia, hyphema, anterior lens luxation and elevated episcleral venous pressure.

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Disclaimer: This page is designed to supply useful information but is not to be regarded as advice specific to any particular case. It does not replace the need for a thorough consultation and all prospective patients should seek the advice of a suitably qualified medical practitioner.