Surgical treatment of glaucoma is the last resort. Most often, the therapy begins with the administration of special eye drops to the patient, the task of which is to lower intraocular pressure, and thus - stop the disease progression. However, in some cases, such treatment is ineffective or cannot be undertaken. Then the solution is the surgical treatment of glaucoma. Check what are the indications for glaucoma surgery and what methods it can be performed.
Surgical treatment of glaucomais usually performed when pharmacological and laser treatment have not stopped the disease progression, i.e. damage to the optic nerve. In addition, surgical intervention should be considered in the case of juvenile glaucoma, large fluctuations in intraocular pressure in daily measurements, adverse effect of the treatment on the quality of life, lack of compliance in the treatment of the patient and / or intolerance of the drops used.
Glaucoma - treatment
The primary goal of therapy is to determine the target pressure, i.e. the highest blood pressure value at which the risk of disease progression is as low as possible.
Treatment should be adapted to the patient's current condition, age and lifestyle.
Treatment of glaucoma patients begins with local pharmacotherapy, but laser trabeculoplasty may be optional, especially in patients with secondary capsular and pigmentary glaucoma.
Only in some cases surgery is the treatment of first choice. They are:
- congenital glaucoma
- primary angle-closure glaucoma with complete or nearly complete angle closure and no pressure control
- the need for a large reduction in intraocular pressure, impossible to achieve with other methods
Surgical treatment of congenital glaucoma
In the case of congenital glaucoma, the firstgoniotomyis performed, which involves cutting the angle of infiltration in order to open it.
The second-line treatment (it is used if the first-line treatment has been unsuccessful or there are contraindications) is Cairns trabeculectomy, which consists in creating a new channel for the outflow of aqueous humorbetween the anterior chamber and the space under Tenon's capsule (glaucoma is most often the result of obstruction of the outflow of aqueous humor through the drainage angle).
The third-line treatment is seton convergences, in the course of which plastic implants are used, which allow for the creation of a connection between the anterior chamber and the space under the Tenon's capsule (Ahmed's valve, Molteno seton).
An alternative are cyclodestructive treatments aimed at reducing the production of aqueous humor, and thus - lowering intraocular pressure (i.e. cyclodiatraemia, diode laser cyclophotocagulation, cyclocryoapplication, diode laser endocyclophotocoagulation).
ImportantThe damage caused by by glaucoma is irreversible and in this case even surgery will not help. The goal of surgical treatment is only to inhibit the development of the disease.
It should also be taken into account that even after surgical treatment, glaucoma may return.
Primary angle-closure glaucoma
In this case, a trabeculectomy is performed, and in the next wave: seton and cyclodestructive procedures.
Surgical treatment of primary open angle glaucoma
Pharmacological treatment in the form of eye drops is usually used in the initial stages of this type of glaucoma. If lowering the pressure is not enough, laser therapy is used. In more advanced cases, and when conservative treatment is ineffective, surgical procedures are performed.
1. Initial to intermediate glaucoma
- non-perforation procedures (facilitating the outflow of aqueous humor and not requiring the opening of the anterior chamber), e.g. deep sclerectomy (involves removing a fragment of the sclera under the previously formed superficial scleral flap and exposing the outer wall of the Schlemm's canal)
- canaloplasty
- minimally invasive treatments
- trabeculectomy
Intermediate to advanced glaucoma
- non-perforating treatments
- canaloplasty
- trabeculectomy
- seton treatments
- transscleral or endoscopic laser cyclophotocoagulation procedures
Surgery for secondary open angle glaucoma
Treatment usually consists of administering eye drops or performing a laser treatment. The final treatment is glaucoma surgery.
Surgery is the same as for intermediate to very advanced primary open-angle glaucoma.
Surgical treatment of secondary angle-closure glaucoma
Treatment usually consists of administering eye drops or performing a laser treatment. The final treatment is glaucoma surgery.
When it comes to surgical procedures, you can choose from:
- fistula treatments - trabeculectomy
- seton treatments
- cyclodestructive treatments
Source: Guidelines of the Polish Ophthalmology Society regarding the surgical treatment of glaucoma.