WHAT IS GLAUCOMA?
Glaucoma is an increase in pressure inside your eye. There is an inability to drain fluid in the natural way. This causes damage to the optic nerve of the eye(s) leading to vision impairment.
The treatment is planned based on the type. Primary open angle glaucoma, the commonest of the types is usually treated with topical eye drops. In case of failure of medication, Laser therapy is advised. The patient should not expect to get back the eyesight that is lost, as it is only performed to reduce the pressure.
Treatment according to type
- Primary angle closure: Initially with medication for pressure reduction and then use of laser therapy
- Secondary: According to the etiology, the treatment can range from eye drops to laser treatment to surgery
- Childhood: Surgery is the only option
Primary angle closure glaucoma
i. Laser Surgery:
The main objective of laser surgery is to reduce the intraocular pressure by draining the fluid from the eyes. The types of OPD based laser procedures are:
a. Trabeculoplasty. This surgery is for people with open-angle glaucoma. The eye surgeon employs a laser to boost the drainage angle. Thus fluid correctly flows out and the eye pressure is reduced.
b. Cyclodiode laser treatment: A laser is used to destroy some of the liquid-producing eye tissue that can minimize the pressure in the eye
c. Iridotomy: This is for those who have glaucoma from the angle closure. The ophthalmologist creates a tiny hole in the iris using a laser. This opening supports air movement to the point of drainage.
ii. Operating room surgery
The following surgeries are performed in an operating room setup.
It provides a new channel for drainage to leave the eye for the aqueous humour.
- Trabeculectomy: A filtration bleb is formed in the conjunctiva by the surgeon and a flap is created in the sclera. The fluid is drained through the flap and into the bleb. And in the bleb, the surrounding tissue of the eye absorbs this fluid, thereby reducing the pressure.
- Glaucoma drainage devices: A reservoir is created under the conjunctiva and a tiny draining tube is implanted which drains the fluid into the reservoir where it is absorbed by the surrounding blood vessels.
iii. Other types of glaucoma surgery:
Trabeculotomy: The procedure is quite similar to trabeculectomy with only difference here being that electric current is used to remove a small part of the eye-drainage tubes
Viscocanalostomy: In this procedure, sclera (outer cover of the eyeball) is removed so as to enable fluid to drain more easily from the eyes. Viscoelastic material is inserted through this opening.
Deep sclerectomy: The constriction of the drainage tube is removed by placing a tiny device inside them
Trabecular stent bypass: a tiny tube is placed inside eye to improve the drainage of fluid
NONPENETRATING GLAUCOMA SURGERY (NPGS)
Newer technological advanced techniques have been developed which help in making superficial incisions without penetrating the eyes deeply. Fewer complications are reported from these types of procedures.
A superficial incision is created into the sclera using a technique called deep sclerectomy and a small portion is removed to create a drainage space, which helps in reducing the pressure.
RISKS INVOLVED WITH THE PROCEDURE
Cataract is the most common risk of glaucoma surgery. Other risks are:
- Eye pain or redness
- Eye pressure that’s still too high or even too low
- Loss of vision
- Bleeding in your eye
There can be recurrence of pressure over time, for which medication needs to be taken as prescribed.
Recovery is dependent on the individual patient, but generally it takes around 6 weeks for the healing process.
CARE AFTER SURGERY
- Avoid rubbing or scratching of eyes
- Take all medications properly as prescribed
- Avoid strenuous activities such as gym or lifting heavy objects
- Avoid taking a dip in swimming pools or tubs as infection can be caught from these places very easily.
OUTCOME OF SURGERY
The outcome of this surgery is very good.
It is important to keep a communication with the surgeon and to visit the hospital / clinic for regular follow-ups as advised.