How is Glaucoma Surgery Done?
Therapy for glaucoma generally starts with eye drops. This will help the patients to decrease the intraocular pressure of the eyes. The progress of vision loss can be slow down by this treatment if the glaucoma is diagnosed at the initial phase. Surgery is recommended by the specialist while initial therapy is not supportive. Laser surgery or incisional surgeries are alternative methods to reduce the intraocular pressure. Usually, the doctors suggest the method which once again depends on the type and severity of the disease. But then, this won’t help the patient to reverse the vision loss.
Laser surgery method for glaucoma has several risks. It involves a small beam of light, which makes a cut or makes the tissue to open in the region where the fluid is accumulated. This procedure enhances the fluid drainage, thus reduce the intraocular pressure.
Selective laser trabeculoplasty is the most common type and safest technique of laser surgery for treating patients with open-angle form glaucoma. This type is very successful and still in practice for more than 25 years. The procedure involves the laser at a very low level, which selectively treats the specific cells leaving the trabecular nerve bundle intact. Hence, this method referred to as “cold laser” technique. Inflammation is common and mild after this type of surgery and can be treated with eye drops or oral non-steroidal anti-inflammatory drugs.
Argon laser trabeculoplasty and micropulse laser trabeculoplasty are some of the alternative methods to selective laser trabeculoplasty for treating glaucoma. Argon laser trabeculoplasty is the first laser trabeculoplasty technique, which uses heat or thermal laser to increase the drainage of the fluids. It is effective for most of the open-angle glaucoma form. It may cause more scarring, but intraocular pressure drops better. Generally, more than half the humor fluid drains during the first regime surgery and lowers the glaucoma pressure by 75%. Medication is still essential for healing the post-operative inflammation.
Micropulse laser trabeculoplasty is analogous to selective laser trabeculoplasty and shares same potential. It intended to decrease the amount of energy which is subjected to optical tissues by pulsing the energy in small increments. Laser cyclophotocoagulation is an alternative method for microsurgery. In this method, the laser is used to clear the hinder present in the ciliary body and ease the fluid channel to drain, thus, lower the eye pressure. The procedure may possibly essential to be repeated in order to control glaucoma 100%.
Laser peripheral iridotomy is useful for treating angle-closure glaucoma. The intraocular pressure elevates when the iris is blocked by an accumulation of humor fluid. Laser peripheral iridotomy creates a slight opening in the iris, allowing the fluid to drain.
In most of the surgery, local anesthesia is prearranged to perform. It creates numbness and patient feels light stinging sensation or no pain. Only after local anesthesia, surgery like laser cyclophotocoagulation is performed without discomfort or pain. Definitely, there will be 5% increase of intraocular pressure after any laser surgeries, which can easily treat by glaucoma medications within 24 hours. All these laser surgeries are a recognized glaucoma treatment and are FDA approved. In some cases, the laser surgeries are repeated because the time of intraocular pressure lowering effect depends on the patient’s age, race, type of glaucoma, and type of factors risks. One of the fascinating advantages of this surgeries is the patients can resume their work after the surgery day and has no definite drawbacks. However, the post-operative medicines are necessary for reducing the inflammation.
Incisional surgery is also called as “filtering surgery” involves the use of small surgical blades for creating a hole to assist the drain in the eyes. If the laser is not promising, the specialist recommends this filtering surgery. More than 90% cases are successful by this surgery and post-operative anti-wound healing drugs are necessary. There may be changes in vision after first 2 months of the surgery and later normal vision resumes. Some cases, the prescription lens is necessary.
- Glaucoma Research Foundation. (n.d.). Glaucoma Surgery. https://www.glaucoma.org/glaucoma/glaucoma-surgery.php
- National Eye Institute. (2019). Glaucoma. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma
- American Optometric Association. (2021). Glaucoma. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/glaucoma
- Mayo Clinic. (2021). Glaucoma. https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839
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