Glaucoma Surgery

Glaucoma is a disease that damages the eye’s optic nerve. The optic nerve is connected to the retina – a layer of light-sensitive tissue lining the back of the eye – and is made up of many nerve fibers, like an electric cable is made up of many wires. It is the optic nerve that sends signals from your retina to your brain, where these signals are interpreted as the images you see.

In the healthy eye, a clear fluid called aqueous (pronounced AY-kwee-us) humor circulates inside the front portion of your eye. To maintain a constant healthy eye pressure, your eye continually produces a small amount of aqueous humor while an equal amount of this fluid flows out of your eye. If you have glaucoma, the aqueous humor does not flow out of the eye properly. Fluid pressure in the eye builds up and, over time, causes damage to the optic nerve fibers.

Glaucoma can cause blindness if it is left
untreated. Only about half of the estimated
three million Americans who have glaucoma
are even aware that they have the condition.
When glaucoma develops, usually you don’t
have any early symptoms and the disease
progresses slowly. In this way, glaucoma
can steal your sight very gradually.
Fortunately, early detection and treatment
(with glaucoma eyedrops, glaucoma surgery
or both) can help preserve your vision.

GLAUCOMA SURGERY
In some patients with glaucoma, surgery is
recommended. Glaucoma surgery improves the flow of fluid out of the eye, resulting in lower eye pressure.

LASER TRABECULOPLASTY
A surgery called laser trabeculoplasty is often used to treat open-angle glaucoma. There are two types of trabeculoplasty surgery: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT).  During ALT surgery, a laser makes tiny, evenly spaced burns in the trabecular meshwork. The laser does not create new drainage holes, but rather stimulates the drain to function more efficiently.

With SLT, a laser is used at different frequencies, allowing it to work at very low levels. SLT treats specific cells and leaves the mesh-like drainage canals surrounding the iris intact. SLT may be an alternative for those who have been treated unsuccessfully with traditional laser surgery or with pressure-lowering drops.

Even if laser trabeculoplasty is successful, most patients continue taking glaucoma medications after surgery. For many, this surgery is not a permanent solution. Nearly half who receive this surgery develop increased eye pressure again within five years. Many people who have had a successful laser trabeculoplasty have a repeat treatment. Laser trabeculoplasty can also be used as a first line of treatment for patients who are unwilling or unable to use glaucoma eyedrops.

LASER IRIDOTOMY
Laser iridotomy is recommended for treating people with closed-angle glaucoma and those with very narrow drainage angles. A laser creates a small hole about the size of a pinhead through the top part of the iris to improve the flow of aqueous fluid to the drainage angle. This hole is hidden from view by the upper eyelid.

PERIPHERAL IRIDECTOMY
When laser iridotomy is unable to stop an acute closed-angle glaucoma attack, or is not possible for other reasons, a peripheral iridectomy may be performed. Performed in an operating room, a small piece of the iris is removed, giving the aqueous fluid access to the drainage angle again. Because most cases of closed-angle glaucoma can be treated with glaucoma medications and laser iridotomy, peripheral iridectomy is rarely necessary.

There are a number of ways to treat glaucoma. While some people may experience side effects from glaucoma medications or glaucoma surgery, the risks of side effects should always be balanced with the greater risk of leaving glaucoma untreated and losing vision.

If you have glaucoma, preserving your vision requires strong teamwork between you and your doctor. Your doctor can prescribe treatment, but it’s important to do your part by following your treatment plan closely. Be sure to take your medications as prescribed and see your ophthalmologist regularly.

In trabeculectomy, a flap is first created in the sclera (the white part of the eye). Then a small opening is made into the eye to release fluid from the eye.

TRABECULECTOMY
In trabeculectomy, a small flap is made in the sclera (the outer white coating of your eye). A filtration bleb, or reservoir, is created under the conjunctiva – the thin, filmy membrane that covers the white part of your eye. Once created, the bleb looks like a bump or blister on the white part of the eye above the iris, but the upper eyelid usually covers it. The aqueous humor can now drain through the flap made in the sclera and collect in the bleb, where the fluid will be absorbed into blood vessels around the eye. Eye pressure is effectively controlled in three out of four people who have trabeculectomy. Although regular follow-up visits with your doctor are still necessary, many patients no longer need to use eyedrops. If the new drainage channel closes or too much fluid begins to drain from the eye, additional surgery may be needed.

AQUEOUS SHUNT SURGERY
If trabeculectomy cannot be performed, aqueous shunt surgery is usually successful in lowering eye pressure.

An aqueous shunt is a small plastic tube or valve connected on one end to a reservoir (a roundish or oval plate). The shunt is an artificial drainage device and is implanted in the eye through a tiny incision. The shunt redirects aqueous humor to an area beneath the conjunctiva (the thin membrane that covers the inside of your eyelids and the white part of your eye). The fluid is then absorbed into the blood vessels. When healed, the reservoir is not easily seen unless you look downward and lift your eyelid.