What is Glaucoma Surgery?
Glaucoma surgery is the only treatment method scientifically proven to be beneficial in the treatment of low intraocular pressure. When we minimize the amount of pressure in our eyes, we also reduce the amount of pressure on our optic nerves, which helps protect nerve cells. Glaucoma surgery is the most effective method to reduce intraocular pressure.
Most eye medications can reduce ocular pressure by 40 to 45 percent; however, surgery can provide a twofold greater reduction. Compared to eye drops for glaucoma, the surgery has several important advantages. Most importantly, it is significantly more effective at reducing ocular pressure changes within 24 hours, especially at night.
How Is Glaucoma Treated?
Treatment of Open Angle Glaucoma
After glaucoma is diagnosed, the primary treatment goals are to reduce the pressure inside the eye to stop damage to the optic nerve and stop the progression of vision loss. Three categories that can be used to classify the many approaches that can be used for this purpose are drug therapy, laser therapy, and surgical therapy.
Treatment for open-angle glaucoma is to reduce intraocular pressure to protect nerve fibers. Glaucoma treatment usually requires the application of various eye drops. These drops reduce the stress inside the eye through various processes.
Some glaucoma medications reduce the amount of intraocular fluid produced, while others make it easier for the fluid inside the eye to drain. Visual field testing and monitoring of the optic nerve head are two ways to evaluate the effectiveness of treatment. The patient will continue with medical therapy until the deterioration in the visual field stops.
If the first effort is unsuccessful, a second drop will be attempted. If the ocular pressure does not begin to drop after two points, the treating physician adds the third drop to the eye drop solution. Before starting treatment with slides, it is necessary to determine whether the patient has heart-lung problems.
As a number of glaucoma eye drops have the potential to cause respiratory problems and heart rhythm disturbances, as a result, extreme caution should be exercised when using such drugs. Again, certain glaucoma drops have been associated with adverse effects, including blurred vision, sore eyes, headaches, and allergic reactions.
Some medications taken orally in pill form are also used to lower intraocular pressure. On the other hand, these drugs are short-term treatments that reduce intraocular stress within a few days. When used for a long time, this drug may cause changes in the electrolyte balance of the blood (especially potassium loss), numbness in the hands and feet, and the formation of kidney stones.
Suppose a glaucoma patient’s intraocular pressure is maintained and reduced to an average level with eyedrop treatment. In this case, the patient should use these drops continuously and routinely for the rest of his life.
Patients who do not respond adequately to pharmacological treatment may be candidates for glaucoma laser therapy as an alternative to surgical intervention. An argon laser can also be given to the trabecular meshes of glaucoma patients as a type of treatment for their disease. Laser therapy can initially return intraocular pressures to normal levels that are not exceptionally high.
This treatment has the potential to reduce eye pressure by approximately 30%. In most cases, the effect will persist for two to three years, but its amplitude will decrease after five years. The pressure within the eye may then start to rise again.
As a result, laser therapy is advantageous at pressures up to 26 mmHg when it is desired to save time in patients who do not comply with drug therapy but cannot be operated. Patients with blood pressure above 26 mmHg may also benefit from laser therapy.
In a patient with glaucoma, surgery may be required if the intraocular pressure cannot be reduced to an average level despite using many medications. This is the case if the damage to the optic nerve worsens over time and the field of vision becomes smaller.
In addition, the physician may need to perform glaucoma surgery at an early age in patients who have difficulty in follow-up, disrupt the use of medication, do not comply with or do not attend the controls. If the surgery is delayed, the patient gradually loses his sight, although it is necessary.
If the patient is a baby or a child, the operation is performed under general anesthesia; If the patient is an adult, the operation is performed under local anesthesia. The operation performed during the surgery will facilitate the outflow of intraocular fluid, which is difficult to get out of the eye and causes increased intraocular pressure.
There are some strategies for achieving this. Trabeculectomy and viscocanalostomy are two surgical procedures used to treat open-angle glaucoma. Each of these treatments aims to create a pathway within the eye that allows the intraocular fluid to exit faster.
After the operation, the patient will not need to lie on his back. The patient’s intraocular pressure may occasionally return to preoperative levels after surgery. It is likely that a second glaucoma surgery will then be needed. In this case, high intraocular pressure is treated by inserting multiple tubes (valves) into the eye and trying to lower it.
After surgery, it is very important to monitor the patient’s visual field. Standard surgical techniques will not yield the expected results in people suffering from highly resistant forms of glaucoma. Some people may need to continue taking medication or undergo other medical treatments after surgery, whether laparoscopic or conventional.
Closed-Angle Glaucoma treatment
The patient will require laser iridotomy once the intraocular pressure returns to normal. In other words, a laser is used to make a hole in the iris of the eye. As a result, fluid in the posterior chamber can pass into the anterior chamber relatively quickly.
This therapy, which takes only a few minutes, is done after the eye has been anesthetized with drops. It can also be applied to the contralateral eye as a prophylactic step. Because the angle on one eye is narrow, the tip on the other side is more likely to be smaller. A gonioscopy procedure can determine whether the angle is shallow or deep.