Surgical Treatment for Open Angle Glaucoma
The treatment of glaucoma is normally progressive, meaning that your doctor will usually treat your glaucoma with medication and laser surgery before recommending micro-surgery. However, if your eye pressure is extremely high or you have severe damage to your optic nerve, surgery can reduce this pressure and prevent further vision loss. It is important to remember that surgery can never restore vision that has already been lost as a result of glaucoma.
Trabeculectomy
In a filtering microsurgery called a trabeculectomy, your highly skilled glaucoma specialist will use a surgical instrument to create a tiny hole and flap in the sclera (the white part of your eye). This will allow the fluid to drain from the eye. During the surgery, you will feel little or no discomfort.
On the day of treatment, you will be welcomed by a staff member at the Ambulatory Surgery Center. The staff will help you prepare for your surgery by putting eye drops in your eye. You will be given a gown to wear over your street clothes during your actual surgery.
You will be given a relaxing sedative along with local anesthetic. An injection will also be given around the eye to prevent movement. The procedure normally takes about 30-40 minutes.
Immediately after the surgery, the surgeon will place a patch over your eye, and you will rest in a comfortable reclining chair. Your family members may then join you in reviewing your follow-up care and schedule. You may be given medication or eyedrops to prevent infection.
Your eye also may be red and teary following the surgery. Your surgeon will check your eyes the morning after surgery to monitor your eye pressure, and check for signs of inflammation and infection. According to the Glaucoma Research Foundation, glaucoma filtering surgery is successful in 70-90 percent of older patients for at least one year.
For at least a week after surgery, you should avoid getting water in your eye. Although you can continue to do most things, you should avoid bending or heavy lifting for the week. This will avoid putting unnecessary strain on the eye.
Following your surgery, which can only be performed on one eye at a time, your eye will remain intact and not deflate. As you heal, a small bubble called a “bleb” will normally form over the opening in your eye. This bleb is usually covered by your eye lid. It is also one sign that your fluid is draining into the surrounding tissue.
Some potential risks following filtering microsurgery are infection, bleb leakage, scarring and cataracts. You will be given medications to help prevent infection. In some patients, particularly younger patients, the drainage hole may begin to close as the body tries to heal itself. Therefore, you may also be given mitomycin-C to slow down the body’s natural healing process and prevent scarring. If the drainage hole should close, the microsurgery can be repeated in the same eye.
Drainage Implants
In some cases, it may be necessary to implant a special type of drain or silicon tube in the eye to drain fluid. Either a Molteno implant or an Ahmed implant may be used. This treatment is often effective in children or people with a secondary type of glaucoma, such as glaucoma caused by uveitis. The tube drains into a plate on the side of the eye, and fluid that collects on the plate is absorbed into the body.
If you require an implant, the procedure will be done in one of the facilities in which we operate. During the surgery, you will feel little or no pain. During the surgery, you will feel little or no discomfort.
On the day of treatment, you will be welcomed by a staff member at the Ambulatory Surgery Center. The staff will help you prepare for your surgery by putting eye drops in your eye. You will be given a gown to wear over your street clothes during your actual surgery.
You will be given a relaxing sedative along with local anesthetic. An injection will also be given around the eye to prevent movement. The procedure normally takes about 45 minutes.
Immediately after the surgery, the surgeon will place a patch over your eye, and you will rest in a comfortable reclining chair. Your family members may then join you in reviewing your follow-up care and schedule. You will be given medication or eyedrops to prevent infection.
You will need to wear the patch for 24 hours and use special eyedrops for a period of time to prevent infection. These drops are different from the eyedrops you normally use to control your glaucoma. The doctor will monitor your condition the morning after your surgery, and continue to do so on a regular basis thereafter.
Some possible risks include infection, very low eye pressure, accelerated cataracts, a detached retina, corneal damage or bleeding. In addition, there is a possibility of eye movement disorders such as crossed eyes or double vision. Most of these complications can be effectively treated. In some patients, the drain can become blocked and require additional surgery.
Glaucoma can’t be cured, but controlling your eye pressure will prevent further damage to your optic nerve. For this reason, following surgery you must continue to be monitored by your doctor on a regular basis. You must also use any medications exactly as they are prescribed to obtain the maximum benefits.