In open-angle glaucoma, aqueous humor, the fluid that normally flows in and out of the eye, has difficulty leaving through the eye's sponge-like drainage system, the trabecular meshwork. When this occurs, pressure within the eye, called intraocular pressure, builds up and may damage the optic nerve and lead to vision loss. So, how do you treat glaucoma? Medications, laser surgery, or other glaucoma surgeries may be used to lower and control the eye pressure. If you're in The Villages & Ocala, FL, schedule your glaucoma surgery with our ophthalmologist, Seaborn M. Hunt III MD.
When Is Glaucoma Surgery Necessary?
When medications or laser treatment cannot lower eye pressure caused by glaucoma, surgery is usually recommended. Of the possible procedures, glaucoma filtration surgery, also called trabeculectomy, is the most common.
How Is A Trabeculectomy Done?
A small flap is made in the sclera or white of the eye. A filtration bleb, or reservoir, is created under the conjunctiva, the thin, clear coating covering the sclera. The aqueous humor inside the eye can now drain through the flap and collect in the bleb, where it is then absorbed into the lymph and blood vessels around the eye. After the bleb is carefully constructed, the incision is closed with tiny stitches. Some of these stitches may be removed or cut with a laser after surgery to increase fluid drainage. Drugs to reduce scarring are often applied during and after surgery.
What Can You Expect If You Have Glaucoma Surgery?
Pain is unusual after surgery, although your eye may feel tender and sensitive. A non-aspirin pain reliever is usually sufficient to treat any discomfort. Sudden, severe or deep-seated pain, especially if it is associated with loss of vision, should be reported to your ophthalmologist immediately.
Eye pressure is adequately controlled in three out of four people. Although follow-up visits are still necessary, many people no longer need to use eye drops. However, if the new opening closes or too much fluid drains from the eye, additional surgery may be necessary.
What will my vision be like?
Vision may fluctuate daily after surgery. Generally your vision is blurry for several weeks. There may or may not be a change in your glasses prescription after surgery. If a cataract is present or another complication exists, vision may not return to what it was before surgery. Surgery cannot restore vision already lost from glaucoma.
As with all surgeries, there are risks associated with a trabeculectomy. One of the most common complications is scarring. Other complications include: infection, bleeding, cataract, and loss of vision.
Although the success rate is quite high, sometime a single surgical procedure cannot halt the progression of glaucoma. Another surgery and/or continued treatment with medications may be necessary.
An eye that has undergone a trabeculectomy and has a functioning bleb will always be susceptible to infection. A red, uncomfortable eye may be a sign of infection and needs to be attended to urgently.
Are there alternatives to glaucoma filtration surgery?
Yes, depending on the type and severity of glaucoma you have and how much the pressure needs to be lowered to halt its progression.
AQUEOUS SHUNT SURGERY
When the risk is high that a trabeculectomy will fail, especially in neovascular glaucoma or glaucoma associated with inflammation in the eye, an aqueous shunt surgery may be recommended. An aqueous shunt is a small tube or valve placed in the eye through a tiny incision. The shunt drains excess fluid into a small reservoir placed on the eye. This surgery, like a trabeculectomy, is an outpatient surgical procedure. Risks of surgery and postoperative care are similar to those for a trabeculectomy.
ARGON LASER TRABECULOPLASTY (ALT)
In argon laser trabeculoplasty, an argon laser makes tiny evenly spaced burns in the trabecular meshwork. The laser does not create new drainage holes, but appears to stimulate the drain to function more effectively. The procedure is performed in an ophthalmologist's clinic with an eye drop anesthetic and can usually be completed within 15-20 minutes. However, the total office time required is from 2 to 3 hours. Eye pressure is monitored after surgery. A few people experience a rise in eye pressure shortly after laser trabeculoplasty. People often need to continue taking some glaucoma medications after laser trabeculoplasty. There is usually little pain associated with this laser procedure and few complications. Laser trabeculoplasty effectively lowers eye pressure three quarters of the time. But for many people, laser trabeculoplasty is not a permanent solution. Nearly half the people who receive laser trabeculoplasty have increased eye pressure again after five years. For people who have had a successful laser trabeculoplasty, it may be repeated with a similar pressure-lowering effect.
When attempts to increase the amount of fluid draining from the eye through the trabecular meshwork fail, reducing the amount of fluid entering the eye is another option. Cyclophotocoagulation is a procedure that uses a laser beam to treat parts of the ciliary body, located behind where the clear cornea meets the while of the eye. The ciliary body produces the aqueous humor. The destruction of parts of the ciliary body reduces production of this fluid, lowering eye pressure. Cyclophotocoagulation is generally used to treat advanced or aggressive open-angle glaucoma and is usually used after other treatments have proven unsuccessful. The procedure, performed with a local anesthetic, can be painful postoperatively and medications for pain and inflammation may be necessary. Your ophthalmologist checks for inflammation and monitors the intraocular pressure in follow-up exams. Risks associated with Cyclophotocoagulation include pain, inflammation and decreased vision for one to six weeks after the procedure. While the risks may sound unpleasant, people with severe glaucoma must reduce intraocular pressure or risk losing vision permanently.
Loss Of Vision Can Be Prevented
Vision loss from glaucoma can be prevented if it is caught and treated in time. Glaucoma filtration surgery is in most people. Although complications may occur, most are treatable. While glaucoma treatments cannot restore vision already lost from glaucoma, early detection and treatment of glaucoma offers the best chance of preserving vision.
We're in the Ocala & The Villages, FL area - schedule an appointment today if you're thinking of getting glaucoma surgery.