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Surgical Procedures for Glaucoma

by Mary Calvagna, MS


When it is not possible to lower the intraocular pressure adequately with eye drops or oral drugs, eye surgery may be advised There are two types of surgery: laser surgery and incisional surgery.

Laser Surgery

This is performed in a doctor's office or an eye clinic. In laser surgery, the surgeon uses a concentrated high-energy beam of light to make changes to the eye to help relieve the intraocular pressure.


The three types most frequently used are:


Trabeculoplasty - This procedure is most often used to treat open-angle glaucoma. Using the laser, the surgeon will make many small microscopic burns in the drainage area of the eye. This will allow the aqueous fluid to drain more freely.


Iridotomy - This surgery is frequently used to treat angle-closure glaucoma or to prevent it in patients who have very narrow drainage angles. Using the laser, the surgeon will make a small hole in the iris. This will allow the aqueous fluid to flow more freely.


Cyclophotocoagulation -This procedure is usually reserved for more advanced or aggressive cases of glaucoma that are refractory to other treatments. Using either the laser or a freezing probe, the surgeon will destroy selected areas of the ciliary body-the part of the eye that produces fluid. This will reduce the production of aqueous fluid.

Description of the Laser Procedure:

The surgeon will place eye drops into your eyes to numb them. You will sit facing the laser machine. Using a special mirrored contact lens held to the front of your eye, the surgeon will focus the high-energy beam of light at specific structures in your eye. You may see flashes of bright green or red light. The process often takes about 15 minutes.


You cannot rub your eyes for at least 20 minutes or until the numbing eye drops have worn off. You may experience some local eye irritation. You will need someone to drive you home after the procedure, but most people can resume their normal activities soon after the procedure.

Incisional Surgery

Also known as filtering surgery, or trabeculectomy, incisional surgery involves the use of tiny instruments to make a tiny, usually partial-thickness, hole in the sclera, or white of the eye. The aqueous humor can now drain out through the hole and be reabsorbed into the bloodstream. This reduces the pressure in the eye. In some cases, the surgeon may place a valve in the eye through a tiny incision. Some types of valves act as a regulator for the buildup of fluid within the eye. When the pressure becomes too high, the valve opens and allows the fluid to flow out and be reabsorbed.

Description of the Procedure:

Incisional surgery is usually performed in an operating room with local anesthesia. The surgeon will make the small incision in the eye to allow for a slow release of aqueous fluid. If necessary, the surgeon will place the tiny valve in the eye through the incision in the sclera. The surgeon will also often cut out a small hole in the iris to help the aqueous fluid flow freely.


You will need someone to drive you home after the procedure. In addition, you may need to wear a patch and use eye drops following surgery. Avoid activities that expose your eye to water, such as swimming and showering, as recommended by your doctor. Also avoid strenuous activities, as recommended by your doctor.

SOURCES:

American Academy of Ophthalmology


The Glaucoma Foundation


National Eye Institute



Last reviewed September 2003 by Marc Ellman, MD


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