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Glaucoma Surgery

The goal of glaucoma treatment is to lower intraocular pressure by causing fluid to drain. If other forms of glaucoma treatment are deemed ineffective, glaucoma surgery offers an excellent alternative, as it can stall vision loss by preventing further damage to the optic nerve.

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When is surgery used for glaucoma treatment?

Surgery generally isn’t the first line of treatment for glaucoma. But if other treatments fail, glaucoma surgery may save your vision.

The goal of glaucoma treatment is to lower your intraocular pressure by helping fluid to drain out of the eye. When the pressure is elevated, it can push on your optic nerve – leading to permanent damage of this nerve and irreversible vision loss. A variety of medicated eye drops can be prescribed to reduce the pressure levels, but they aren’t effective for everyone, especially when pressure levels are very high and need to be lowered quickly. Or sometimes eye drops for glaucoma can sting and even occasionally causes serious side effects, such as hypertension, which makes it a poor option for glaucoma treatment.

These are cases when our eye doctor in Glenn Dale and College Park, MD, may recommend glaucoma surgery.

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Types of Glaucoma Surgery

Typically, your eye doctor will perform laser surgery first. These procedures are done on an outpatient basis.

Laser surgeries for glaucoma include:

  • Argon laser trabeculoplasty (ALT): This procedure opens blockages in your eye, allowing fluid to drain properly.
  • Selective laser trabeculoplasty (SLT): when ALT isn’t fully effective, this procedure may be used. SLT works by aiming a precisely targeted low-level laser at only the spots with elevated pressure.
  • Laser peripheral iridotomy (LPI): when the gap between your iris and cornea is smaller than normal, narrow-angle glaucoma may develop. With this kind of glaucoma, fluid and pressure build up in this small area of the eye. Using a laser beam, LPI creates a tiny hole in the iris through which the excess fluid can drain.
  • Cyclophotocoagulation (CP): when all other laser treatments do not relieve the fluid buildup and lower pressure, cyclophotocoagulation may be used. This operation aims a laser beam through the sclera and into the ciliary body, which is the part of the eye that produces intraocular fluid. The laser damages the ciliary body so it makes less eye fluid. Cyclophotocoagulation may be repeated over time to keep pressure levels normal.

MIGS: Micro-invasive glaucoma surgery

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In the world of glaucoma treatment, the term MIGS is being heard more and more. This abbreviation stands for “micro-invasive glaucoma surgery,” and refers to a range of procedures developed in recent years to lower the complication rate and recovery time of glaucoma surgery. MIGS are performed with microscopic-sized devices and tiny incisions, some of these devices are only 0.3mm wide, which is only ten times the width of a human hair. This new approach to glaucoma surgery demonstrates a much higher level of safety for patients.

The types of MIGS include micro trabeculectomies, trabecular surgery, suprachoroidal shunts, and milder versions of laser photocoagulation.

MIGS have been around for about a decade, and there is still some debate about the overall effectiveness, especially in advanced glaucoma. Generally, the best results are seen when treating mild to moderate cases of glaucoma. However, the advantages of MIGS contribute to its popularity: it offers few risks, minimal post-operative care, a shorter recovery period, and less time in the hospital.

Conventional non-laser glaucoma surgery:

If laser surgery doesn’t alleviate eye pressure, you may need a different type of procedure.

  • Trabeculectomy: a small incision will be made in the white part of your eye to remove some of the inner mesh of tissue, helping the excess fluid to drain. Medication to prevent scar tissue may also be administered. Research shows that this procedure lowers eye pressure in 6-8 out of 10 people and may be most effective in people who haven’t had previous eye trauma or surgery (for glaucoma, retina surgery, cataracts, or eye muscle problems).
  • Drainage implant surgery: a tiny tube will be inserted inside your eye to facilitate fluid draining. Many minimally invasive implants are now available.
  • Electrocautery: a heat device, called a Trabectome, is used to make a small incision in the drainage tubes of your eye, which sends heat to the inner mesh of tissue and relieves fluid pressure. Electrocautery is less invasive than trabeculectomy or drainage implants.

Risks of Glaucoma Surgery

The primary risk of glaucoma surgery is that it increases your chances of developing cataracts later on. Other possible risks include:

  • Red eyes
  • Eye pain
  • Abnormal eye pressure – too high, or even too low
  • Vision loss
  • Eye infection
  • Inflammation or bleeding in your eye

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Benefits of Glaucoma Surgery

When other types of glaucoma treatment, including eye drops and medications, are ineffective or unsuitable, glaucoma surgery offers an excellent alternative to prevent damage to your optic nerve and permanent vision loss. Unfortunately, as with all damage to the nerves, if you’ve already lost vision due to glaucoma, surgery will not be able to restore it – but it can prevent further damage and save your remaining sight!

For glaucoma diagnosis and management, be sure to visit our eye doctors in Glenn Dale and College Park, MD, for regular comprehensive eye exams.