Glaucoma Surgery – Common Methods

Glaucoma is a condition that can damage the optic nerve and affect your vision. Surgery can be an option to reduce intraocular pressure (pressure inside the eye), allowing you to stop or reduce the amount of medication you use. Let's follow the article below with Light to get the most comprehensive overview of glaucoma surgery methods, the detailed steps in the surgical process, and the essential post-operative care tips you need to know!

What is Glaucoma?

Glaucoma, also known as "the silent thief of sight," is a group of eye diseases that damage the optic nerve. The disease typically affects peripheral vision but can lead to progressive vision loss and blindness over time. There are many causes of glaucoma; therefore, treatment depends on each patient's specific condition. Glaucoma cannot be completely cured but can be managed with medications and surgery to help prevent or slow the progression of vision loss. Eye drops and other medications are often considered the first-line treatment option chosen by ophthalmologists to treat glaucoma. The purpose of these medications is to reduce excess aqueous humor in the eye and lower pressure on the optic nerve. In some cases, medications may not effectively control glaucoma. When this occurs, ophthalmologists may recommend laser treatment or conventional incisional surgery.

Methods of Glaucoma Surgery

The goal of glaucoma surgery is to improve the drainage of aqueous humor by either making it easier for the fluid to drain out or by reducing the amount of fluid the eye produces. Laser glaucoma treatments include several types, such as:

• Laser trabeculoplasty for open-angle glaucoma.
• Laser peripheral iridotomy.
• Cyclophotocoagulation (diode laser treatment).

In cases where patients opt for incisional surgery (using a scalpel), the procedures include:

• Trabeculectomy (filtering surgery).
• Drainage valve/shunt implantation.
• Minimally Invasive Glaucoma Surgery (MIGS).

Methods of Glaucoma Laser Treatment

Laser trabeculectomy for open-angle glaucoma

Laser trabeculectomy for open-angle glaucoma is a quick, minor procedure that can be performed right in the doctor's office or clinic. There are two types of laser trabeculectomy, including:

• Argon Laser Trabeculoplasty (ALT)
• Selective Laser Trabeculoplasty (SLT)

Both of these laser types help lower intraocular pressure by targeting blockages within the eye's natural drainage system. The ALT method has largely been replaced by the newer SLT version because SLT is highly selective and can be repeated multiple times, unlike ALT. Recent studies also support using this laser treatment method as a first-line therapy in managing Glaucoma. However, this method is not suitable for certain types of glaucoma, such as angle-closure glaucoma.

Laser peripheral iridotomy

This is a method that uses a laser to create a tiny hole in the iris, allowing the aqueous humor to flow freely. Phương pháp cắt mống mắt chu biên với tia laser có tác dụng với những người mắc bệnh Glaucoma góc đóng. Typically, doctors use this method to prevent and treat glaucoma.

Cyclophotocoagulation

This is a laser treatment method for Glaucoma patients that works by reducing pressure and lowering the production of aqueous humor inside the eye. Cyclophotocoagulation targets the metabolic process of the eye's aqueous humor, meaning the way the fluid is produced. The reason is that many cases of glaucoma are related to an excess of aqueous humor in the eye, causing a buildup that leads to increased intraocular pressure. Patients will remain fully awake during the cyclophotocoagulation surgical procedure. Doctors will numb the eye using local anesthesia, and the surgical process takes only a few minutes. In some cases, the effectiveness of this method may not last; patients may experience a relapse of Glaucoma, causing the eye to produce more aqueous humor and increasing the pressure inside the eye.

Methods of Glaucoma Surgery

Trabeculectomy

This surgical procedure is used for both angle-closure glaucoma and open-angle glaucoma. Trabeculectomy is a major surgical procedure that typically takes about one hour or less to complete. The surgery may be performed under local anesthesia (the patient remains awake) or general anesthesia (the patient is asleep). The ophthalmologist will determine the most appropriate anesthesia method for the procedure. During surgery, a very small portion of the iris is removed, and a drainage pathway is created from the anterior chamber angle to the subconjunctival space. This allows aqueous humor to drain out of the eye, thereby lowering intraocular pressure. The conjunctiva is then sutured and restored to its normal position. After the procedure, the surgeon will place an eye shield over the operated eye, and the patient may be discharged. The patient should continue wearing the eye shield until the follow-up visit with the surgeon the next day, when the postoperative examination schedule will be determined. The surgeon will remove the sutures once the eye has healed sufficiently, usually about 2 weeks after surgery.

Anterior chamber drainage valve/shunt implantation

This procedure is recommended for patients with glaucoma whose intraocular pressure is difficult to control. The surgery may take between 1 and 2 hours and involves the implantation of a glaucoma drainage device. The drainage device helps reduce intraocular pressure by allowing more aqueous humor to drain from the eye. The procedure is usually performed under local anesthesia; however, in some cases, patients may require general anesthesia.

Minimally invasive glaucoma surgery – MIGS

This is a method that uses microscopic incisions and extremely small devices to reduce the pressure inside your eye. The MIGS surgical process takes only a few minutes. In addition, the patient's recovery process will also happen faster compared to other types of surgery. MIGS is typically used only for mild cases of glaucoma, but nowadays, this method is becoming increasingly popular and applied in many places. Although MIGS is a Glaucoma surgical method that features a shorter operation time and a lower risk of complications. However, some experts argue that this method is not as effective as gold-standard surgical alternatives, such as trabeculectomy. Besides, the cost of the small and specialized equipment required to perform a MIGS procedure is also very expensive. This can cause difficulties for patients when it is not covered by insurance.

Detailed Steps of Glaucoma Surgery

 

Before glaucoma surgery

Before the surgery, patients will be examined and advised by doctors on issues such as:

• Performing eye checks using diagnostic tests.
• The patient's expectations before, during, and after surgery.
• Reviewing the patient's medical history and current medications being used.

In addition, the doctor will also provide detailed pre-operative instructions for the patient. These tasks may vary from person to person. But generally, patients may need to:

• Avoid using non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, or anticoagulants (blood thinners).
• Have a family member accompany them to drive the patient to the hospital and back home after discharge.
• Ensure which medications can be used or must not be used before undergoing surgery.
• Fast (stop eating or drinking) for a few hours before surgery; this depends on the method of local or general anesthesia.

During Glaucoma Surgery

What happens during the procedure depends on the type of glaucoma surgery being performed. In general, glaucoma surgery is an outpatient procedure, meaning that patients can return home on the same day. Depending on the treatment method selected by the ophthalmologist, patients may receive local anesthesia, anesthetic eye drops, and/or anesthetic injections around the eye. For laser treatments, the procedure is typically performed in the ophthalmologist’s clinic or office. If the patient undergoes trabeculectomy, glaucoma drainage device implantation, minimally invasive glaucoma surgery (MIGS), or transscleral cyclophotocoagulation, the procedure will be carried out in an operating room. Patients may require intravenous (IV) sedation or general anesthesia. With IV sedation, patients will experience less pain and discomfort while remaining awake during the procedure. In contrast, patients receiving general anesthesia will be unconscious throughout the surgery.

How long does Glaucoma surgery take?

Most laser glaucoma treatment methods take only a few minutes. The operation time for MIGS procedures will vary depending on the specific protocol and whether the surgeon is performing concurrent cataract surgery. In addition, the operation time for MIGS methods is generally less compared to traditional surgeries, such as trabeculectomy and shunt/valve implantation, which can take up to about an hour.

What to do after surgery

In cases where patients undergo procedures under local anesthesia at the clinic, they can be discharged and return to their daily routines. If a patient undergoes a Glaucoma surgical method that involves general anesthesia or sedation, the patient will need a driver or a relative to take them home. After surgery, the patient will need to return to see the ophthalmologist for follow-up appointments to monitor intraocular pressure and the eye's recovery process.

Is Glaucoma surgery painful?

The surgeon will use anesthetic and sedative medications to ensure that the patient does not experience pain during the procedure. Patients may experience soreness, discomfort, and irritation after surgery.

How long is the recovery time after Glaucoma surgery?

Recovery time will vary depending on the specific surgical method and the condition the patient has. For treatments conducted at the clinic, patients only need one day to rest and can then return to normal activities. For other surgeries, patients may need to restrict certain activities, such as avoiding lifting heavy objects, for up to a month. Typically, patients will be prescribed eye drops and will receive a follow-up appointment schedule to monitor visual acuity and intraocular pressure (pressure inside the eye). Patients may need to have a bandage applied to the eye and must keep it dry for a certain period of time. You should not rub the eye until the surgeon informs you that it is safe to do so.

When should you contact a doctor?

 

The surgeon will provide instructions to the patient regarding when to call and when to meet them for a follow-up exam after discharge. Typically, patients should call the doctor if they experience symptoms such as:

• Severe eye pain.
• Loss of vision.
• Redness, watering, or eye discharge that becomes increasingly severe.

Through this article, Hikari hopes you now have a comprehensive overview of glaucoma surgery. If you are experiencing ocular conditions such as cataracts, glaucoma, or related disorders, please contact Hikari Eye Care to be examined and consulted by a team of highly qualified physicians with extensive experience in ophthalmology.

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