Since vision loss due to glaucoma is irreversible , the goal of glaucoma treatment is to control progression of vision loss after early diagnosis .It could be treated with eyedrops , pills , laser surgery, traditional or conventional surgery , or combination of surgeries.
EYEDROPS –
After instilling any antiglaucoma eyedrop , close your eyes for 1-2 mins & press index finger lightly
against inferior nasal corner to close tear duct which drains into nose . This is to maximise the
amount of drug absorbed in the eye & minimize absorption into bloodstream .
PILLS –
If IOP is not controlled with eyedrops , pills are used in addition to eyedrops . pills need to be
administered 2 – 4 times /day as requirement . They do have systemic side effects , hence prior
systemic evaluation & history of any pre existing illness required before administration of pills .
PROCEDURES –
When desired results are not achieved with medications or patient experiences intolerable
side effects , then surgical correction is needed .
*LASER SURGERY –
It is an intermediate step between drugs & traditional surgery (TRABECULOPLASTY ).It is used to
treat OPEN ANGLE GLAUCOMA
1)ARGON LASER TRABECULOPLASTY –
Treats trabecular meshwork of the eye increasing aqueous drainage outflow , thereby decreasing
intraocular pressure
2)SELECTIVE LASER TRABECULOPLASTY –
Newer laser which uses low energy , selects part of trabecular meshwork & leaves few parts
intact,unlike other types , it can be safely repeated .
*LASER PERIPHERAL IRIDOTOMY –It is used to treat ANGLE CLOSURE GLAUCOMA .Opening is made
through iris , allowing aqueous fluid to flow from behind the iris , directly into Anterior chamber of
the eye , thereby fluid bypasses its normal route .
*CYCLOABLATION –Transcleral cyclophotocoagulation uses a laser to direct energy through outer
sclera of the eye to reach & destroy portions of ciliary processes without damaging overlying tissues
With Endoscopic cyclophotocoagulation instrument is placed inside the eye , through surgical
incision , so laser energy is applied directly to ciliary body .
*TRADITIONAL SURGERY –Conventional surgery TRABECULECTOMY is preferred when medication &
laser treatment do not adequately lower Intraocular pressure . It is used in Open as well as Angle
closure glaucoma . Surgeon creates passage in sclera for draining excess eye fluid.Flap is created to
allow the fluid to escape , but does not deflate the eyeball . On superior surface of eyeball over
limbus , small bubblle of fluid called BLEB is created , which ios a sign that fluid is draining into space
between sclera & conjunctiva . Ocassionally the BLEB closes & IOP rises since the body tries to heal
the opening targeting it as injury.Hence many surgeons use antifibrotic agents like Mitomycin C or
5 FU during surgery to prevent scarring .50% patints do not require Antiglaucoma medication for
significant length of time post surgery .
* DRAINAGE IMPLANT SURGERY – Several types of drainage devices are available which have a
similar design consisting of small silicone tube that extends into anterior chamber of the eye .The
tube is connected to one or more plates which are sutured to surface of the eye .Fluid is collected on
plate & absorbed by tissue in eye preferred in patients whose pressure is not controlled by
trabeculectomy or who have previos scarring
* NON PENETRATING SURGERIES -It is a promising surgery in future, since it minimizes post
operative complication , lowers risk of infection as it does not enter Anterior chamber ., but it
requires greater surgical Acument. Furthermore longterm studies are neededto assess these
procedures & to determine their role in clinical management of glaucoma patients .
*PROMISING SURGICAL ALTERNATIVES –
1)EXPRESS MINIGLAUCOMA SHUNT -stainless steel like device inserted into Anterior chamber of eye
& placed under scleral flap .It offers an alternative to either repeating Trabeculectomy or placing a
more extensive silicone tube shunt in patients whose IOP is higher than the optic nerve can tolerate
2) TRABECTOME – New probe like device that is inserted into anterior chamber through cornea . It
delivers thermal energy to trabecular meshwork , reducing resistance to outflow of aqueous humour
, resulting in reduction of IOP
3) CANALOPLASTY – Recent advancement in non penetrating surgery. It is compared to an ocular
version of Angioplasty in which physician uses extremely fine catheter to clear drainage canal
For more information take appointment today itself with Dada Laser Eye Institute !
