Glaucoma is a chronic disease in which increased intraocular pressure, along with other factors, causes irreversible damage to the optic nerve with the consequent decrease in visual field and loss of vision that can lead to blindness.
There are different surgical techniques being the most effective trabeculectomy or deep non-perforating sclerectomy, in which a subconjunctival bleb is created through which circulate the aqueous humor (the aqueous humor is a colorless liquid that is in the anterior chamber of the eye, it nourishes and oxygenates the structures of the eyeball that have no blood supply, such as the cornea and the crystalline), thus achieving lower intraocular pressure.
Sometimes it is necessary to place a valvular implant, which is an artificial system to evacuate the aqueous humor.
In a first attempt, it is tried to diminish the intraocular pressure by means of the use of eye drops, but when these fail or are not able to prevent the progression of the disease, it is necessary to resort to other therapeutic techniques. Sometimes a laser treatment called trabeculoplasty is useful. If the above is not enough, you should appeal for the surgery.
What to Expect After Glaucoma Surgery?
The severity of the complications decreases thanks to the monitoring of the patient during anesthesia and the presence of personnel prepared to cope with them. The indication of a glaucoma surgery must be preceded of an individualized study of the patient, with the objective of achieve the best results in the context of the lowest rate of related complications.
Before The Intervention, Several Factors Must Be Taken Into Account:
- Type of glaucoma.
- Target intraocular pressure.
- Ocular and systemic antecedents (previous surgeries, ocular and systemic diseases, medications, allergies).
- Complete ophthalmologic examination, degree of loss of the visual field.
- Patient’s risk profile (contralateral eye state, age, occupation, refraction).
- Preferences and experience of the surgeon.
- Risk of complications, individual and general.
- Opinion and patient expectations related to surgery.
When performing the surgery, it is foreseeable that a decrease in intraocular pressure will be achieved, for either bringing it to normal levels or to achieve a sufficient partial reduction to stabilize or slow down the course of the disease.
If glaucoma surgery is not performed when there are indications for it, the disease continues its course; there is a progressive atrophy of the optic nerve with the consequent loss of visual field, even leading to total blindness.
Despite the appropriate choice of the surgical technique and its correct performance, undesirable effects can occur both at eye level and in other organs and systems.
Possible Complications at Eye Level Are:
- Hyphema: It is a bleeding from the anterior chamber of the eye that is resolved with medical treatment.
- Uveitis: Intraocular inflammation that is solved with medical treatment and is not usually very intense.
- Decreased visual acuity due to cataract formation.
- Ocular hypotonia due to excessive reduction of intraocular pressure.
Sometimes it is not possible to reduce the ocular tension and it is necessary to re-operate or add medical treatment. Among The Rare Risks Are:
- Very serious intraocular hemorrhage of the expulsive type (0.05-0.4%).
- Failure of filtering surgery.
- Uveitis or serious inflammation.
- Opening the postoperative suture with a filtering wound.
- Severe intraocular bleb (blebitis) or ocular infections (endo/panophthalmitis).
- Malignant glaucoma: rise in tension after the operation that requires its urgent reintervention.
- Choroidal and retinal detachment.
Risks Depending on The Clinical Situation of The Patient
In most cases anesthesia is local, by injection around the eye, unless better advice from the ophthalmologist or anesthesiologist.
A consultation with the anesthesiologist prior to the intervention is necessary, which will make the necessary preoperative tests after assessing drug allergies, previous operations, illnesses suffered, and medication taking.
In most cases, patients do not feel pain. The surgery is usually performed with local anesthesia and relaxing medications. Generally, a limited type of anesthesia called intravenous (IV) sedation is used.
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