Glaucoma Surgery Types

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What types of surgery are there for open-angle glaucoma?

Open-angle glaucoma is a type of eye disease that causes progressive damage to the optic nerve, leading to vision loss. While there is no cure for glaucoma, there are several types of surgery that can help manage the condition and prevent further damage to the optic nerve.

Some of the surgical options for open-angle glaucoma include:

Trabeculectomy

This is the most common surgery for open-angle glaucoma. In this procedure, a small flap is created in the eye to allow fluid to drain out of the eye and reduce intraocular pressure.

Canaloplasty

This procedure is designed to enhance the eye’s natural drainage system by widening the eye’s drainage canal. A small catheter is inserted into the canal to open it up and then removed.

Goniotomy

This procedure involves making a small incision in the eye to access the drainage system and remove any blockages that are causing increased intraocular pressure.

Laser trabeculoplasty

This procedure involves using a laser to improve the eye’s natural drainage system. The laser is used to stimulate the tissue around the eye’s drainage canal to enhance fluid outflow.

iStent

This is a tiny implant that is inserted into the eye to increase the drainage of fluid out of the eye.

The specific type of surgery recommended for open-angle glaucoma will depend on the severity of the condition, the patient’s overall health, and other individual factors. It’s important to consult with an experienced eye surgeon to determine the best course of treatment for each individual case.

What to expect for different types of glaucoma surgery?

Here’s a brief overview of what to expect for each of the surgical procedures commonly used for open-angle glaucoma:

Trabeculectomy

This procedure is performed under local anesthesia and typically takes about an hour to complete. During the procedure, the surgeon creates a small flap in the eye to allow fluid to drain out, which can reduce intraocular pressure. After the surgery, patients may experience mild discomfort and redness, and they will need to use eye drops to help prevent infection and reduce inflammation. Follow-up visits with the surgeon will be required to monitor healing and assess the effectiveness of the surgery.

Canaloplasty

This procedure is also performed under local anesthesia and usually takes about an hour to complete. During the procedure, the surgeon inserts a small catheter into the eye’s drainage canal to open it up and enhance fluid outflow. Patients may experience mild discomfort and redness after the procedure and will need to use eye drops to help prevent infection and reduce inflammation. Follow-up visits with the surgeon will be required to monitor healing and assess the effectiveness of the surgery.

Goniotomy

This procedure is typically performed under general anesthesia or local anesthesia with sedation and takes about 30-60 minutes to complete. During the procedure, the surgeon creates a small incision in the eye to access the drainage system and remove any blockages. Patients may experience mild discomfort and redness after the procedure and will need to use eye drops to help prevent infection and reduce inflammation. Follow-up visits with the surgeon will be required to monitor healing and assess the effectiveness of the surgery.

Laser trabeculoplasty

This procedure is typically performed in the doctor’s office and takes about 10-15 minutes to complete. During the procedure, the surgeon uses a laser to stimulate the tissue around the eye’s drainage canal to enhance fluid outflow. Patients may experience a mild discomfort and sensitivity to light after the procedure and will need to use eye drops to help prevent infection and reduce inflammation. Follow-up visits with the surgeon will be required to monitor the effectiveness of the surgery.

iStent

This procedure is typically performed under local anesthesia and takes about 10-15 minutes to complete. During the procedure, the surgeon inserts a tiny implant into the eye to enhance fluid outflow. Patients may experience mild discomfort and redness after the procedure and will need to use eye drops to help prevent infection and reduce inflammation. Follow-up visits with the surgeon will be required to monitor healing and assess the effectiveness of the surgery.

Overall, recovery times for these procedures can vary, but most patients can expect to resume normal activities within a few days to a few weeks after the surgery, depending on the type of procedure performed. It’s important to follow the surgeon’s instructions for post-operative care, including using prescribed medications and attending follow-up appointments, to ensure the best possible outcomes.

What is Minimally Invasive Glaucoma Surgery (MIGS)?

Minimally Invasive Glaucoma Surgery (MIGS) refers to a group of surgical procedures that are designed to reduce intraocular pressure in a minimally invasive way. Unlike traditional glaucoma surgeries, which involve making large incisions in the eye, MIGS procedures involve making small incisions or using tiny devices to enhance the eye’s natural drainage system.

Some of the common MIGS procedures include:

iStent

This is a tiny implant that is inserted into the eye’s drainage canal to enhance fluid outflow.

Trabectome

This procedure involves using a small probe to remove a portion of the eye’s trabecular meshwork, which can help improve fluid outflow.

Canaloplasty

This procedure involves using a small catheter to enhance the eye’s natural drainage canal and improve fluid outflow.

Hydrus microstent

This is a small, flexible tube that is inserted into the eye’s drainage canal to enhance fluid outflow.

MIGS procedures are typically performed on an outpatient basis and under local anesthesia. The procedures are minimally invasive, so patients generally experience less discomfort and have a shorter recovery time compared to traditional glaucoma surgeries. MIGS procedures are generally recommended for patients with mild to moderate glaucoma and are often used in combination with medications to manage intraocular pressure.

It’s important to note that not all patients with glaucoma are good candidates for MIGS procedures, and the specific procedure recommended will depend on the patient’s individual needs and the severity of their glaucoma. As with any surgical procedure, it’s important to discuss the risks and benefits of MIGS with an experienced eye surgeon to determine the best course of treatment for each individual case.

Types of glaucoma surgeries for Primary Angle-Closure Glaucoma

The primary treatment for Primary Angle-Closure Glaucoma (PACG) is laser iridotomy, which involves creating a small hole in the iris to allow for better fluid drainage and to relieve pressure on the optic nerve. In addition to laser iridotomy, there are several surgical options available for patients with PACG who do not respond to medications or laser treatments. These surgical procedures include:

Trabeculectomy

This procedure involves creating a small flap in the eye to allow fluid to drain out, which can reduce intraocular pressure. This is the most common surgical procedure used for PACG.

Goniosynechialysis

This procedure involves removing adhesions that have formed between the iris and the drainage angle of the eye, which can help to improve fluid outflow.

Viscoelastic device-assisted deep sclerectomy

This procedure involves creating a small pocket between the outer layer of the eye (the sclera) and the drainage system to enhance fluid outflow.

Endoscopic cyclophotocoagulation

This procedure involves using a small endoscope to visualize the ciliary body of the eye, and then using a laser to destroy some of the tissue to reduce the production of intraocular fluid.

It’s important to note that the type of surgery recommended for PACG will depend on the severity of the condition and the individual patient’s needs. As with any surgical procedure, there are risks associated with these surgeries, and patients should discuss these risks with their eye surgeon before undergoing any treatment.

Which procedures are glaucoma laser surgery types?

Glaucoma laser surgery, also known as laser trabeculoplasty, is a non-invasive procedure that uses a laser to improve the drainage of fluid in the eye, which can help to lower intraocular pressure. There are two main types of glaucoma laser surgery:

Argon laser trabeculoplasty (ALT)

This type of laser eye surgery for glaucoma involves using an argon laser to treat the trabecular meshwork of the eye, which is responsible for draining fluid. The laser creates small burns in the meshwork, which stimulates the cells to increase fluid drainage.

Selective laser trabeculoplasty (SLT)

This type of laser surgery uses a different type of laser, called a Q-switched frequency-doubled Nd:YAG laser, to target specific cells in the trabecular meshwork. Unlike ALT, SLT does not create burns but instead uses low-level energy to stimulate the cells and improve fluid drainage.

Both ALT and SLT are outpatient procedures that can be performed in a doctor’s office or clinic. The procedure usually takes only a few minutes, and patients may experience some mild discomfort or blurry vision afterward. However, most patients are able to resume normal activities shortly after the procedure. Glaucoma laser surgery is generally considered safe and effective, but as with any medical procedure, there are potential risks and complications, and patients should discuss the benefits and risks of the procedure with their eye doctor.

What are the different types of glaucoma surgery for Neovascular Glaucoma?

Neovascular Glaucoma (NVG) is a type of glaucoma that develops as a result of abnormal blood vessels growing on the iris and over the drainage angle of the eye, which can lead to increased intraocular pressure. The treatment for NVG typically involves addressing the underlying condition causing abnormal blood vessels growth, such as diabetes or retinal vein occlusion. However, if the intraocular pressure is not adequately controlled with medication and laser treatment, surgery may be necessary. The following are some of the surgical options available for treating NVG:

Trabeculectomy

This procedure involves creating a small flap in the eye to allow fluid to drain out, which can reduce intraocular pressure. This is the most common surgical procedure used for glaucoma, including NVG.

Ahmed valve implantation

This procedure involves implanting a small valve device into the eye to enhance fluid outflow and reduce intraocular pressure.

Cyclophotocoagulation

This procedure involves using a laser to destroy some of the cells in the ciliary body of the eye, which can reduce the production of intraocular fluid and lower the pressure.

Endoscopic cyclophotocoagulation

This procedure is similar to cyclophotocoagulation but involves using an endoscope to visualize the ciliary body and direct the laser.

The choice of surgical procedure will depend on the severity of the NVG and the individual patient’s needs. As with any surgical procedure, there are risks associated with these surgeries, and patients should discuss these risks with their eye surgeon before undergoing any treatment.

Conclusion

The benefits of having surgery for glaucoma depend on the individual patient’s condition, the severity of their glaucoma, and their response to other treatments. Generally, surgery is recommended for patients whose intraocular pressure is not adequately controlled with medication and/or laser treatment. The benefits of surgery over other treatments may include:

Lower intraocular pressure

Surgery is often able to lower intraocular pressure more effectively than medication or laser treatment, which can help to slow or stop the progression of glaucoma and reduce the risk of vision loss.

Long-term efficacy

Surgery may provide a longer-lasting reduction in intraocular pressure compared to medication or laser treatment, which may require ongoing treatment and monitoring.

Reduced medication burden

Surgery may allow some patients to reduce or even eliminate their need for glaucoma medications, which can have side effects and be expensive.

Improved quality of life

By reducing intraocular pressure, surgery may improve a patient’s visual function and reduce the impact of glaucoma on their daily life.

However, it’s important to note that surgery also carries risks, such as infection, bleeding, and vision loss, and may require a longer recovery period compared to other treatments. Patients should discuss the benefits and risks of all treatment options with their eye doctor before making a decision.

FAQ’s

What is the latest glaucoma procedure? 

Your doctor can suggest a novel procedure known as minimally invasive glaucoma surgery if you have mild glaucoma (MIGS). This similarly decreases eye pressure, but it comes with less drawbacks and hazards and speeds up your recovery. 

How long does healing after glaucoma surgery take? 

Although recovery times following glaucoma surgery vary depending on the patient and the procedure, most people recover between 3 to 6 weeks. Set aside the day following surgery for healing. Patients with postoperative glaucoma are often advised to refrain from intense exercise for the remainder of the healing period. 

Which surgery for glaucoma is the best?

Trabeculectomy.  Trabeculectomy is the gold standard for treating advanced open-angle glaucoma. It has a greater complication rate and is more intrusive than MIGS or laser treatments, but it normally lowers ocular pressure extremely well, according to the doctors.

About the Author:
Dr. Shaun Larsen

Dr. Shaun Larsen

Dr. Shaun Larsen is an optometrist who specializes in low vision services and enhancing vision with contact lenses. He has a passion for making people's lives better by helping them see well enough to read, write, or drive again. He always keeps up with the latest technology so he can help people regain their independence.

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